FOREWORD AND Page 4 SOIL-TRANSMITTED HELMINTHIASIS 1 8Page 28 2019 THIS YEAR’S REPORT Page 34 COUNTRIES SUPPORTED AT A GLANCE 44 Page 8 + 2 9 700INDIVIDUALS TRAINED ABOUT ESPEN STRENGTHENING 236,427,988TABLETS SAVED FROM WASTE Page 11 INFORMATION MANAGEMENT SYSTEMS 3 10Page 42 PREVENTIVE CHEMOTHERAPY SDGs AND NTDs IMPROVING THE EFFECTIVE Page 14 USE OF DONATED 778DISTRICTS 4 11MEDICINES THROUGH ENHANCED SUPPLY CHAIN 61,258,027 INDIVIDUALS TARGETED MANAGEMENT SYSTEMS NTDs IN AFRICA Page 46 Page 18 ESPEN COLLECT 5 8COUNTRIES LYMPHATIC FILARIASIS PARTNERSHIPS, 1,615SURVEYS Page 20 COORDINATION AND RESOURCE MOBILISATION 6 12Page 49 PORTAL FINANCIAL OVERVIEW 153COUNTRIES Page 24 Page 51 9,255USERS 7 13 REFERENCES 14Page 52 Dr. Maria Rebollo Polo, ESPEN Team Leader (left) Dr. Matshidiso Moeti, WHO Regional Director for Africa (right)

FOREWORD As NTD programme managers, we work to protect people from the diseases of and neglect and empower the communities we serve. We started 2019 with great optimism, as another year to work towards making the world a Dear Friends, healthier place, igniting hope for children, men and women in Africa who are at risk of these diseases, so In the past year, member states and partners have reached more than 61 that families and communities could thrive. Despite the long road that remains ahead of us, 2019 has seen considerable million people with preventive medicines through the Expanded Special progress towards achieving our goals of control and elimination of neglected tropical diseases. In July 2019, we Project for Elimination on Neglected Tropical Diseases (ESPEN). This dramatic gathered in Addis Ababa for our annual meeting, the very place where the Addis Ababa NTD commitment was achievement builds on the giant strides and unprecedented collaboration 5 signed. We call for the implementation of the commitments entered by our ministers for increased domestic funding, 1 that have taken place since the partnership was launched in 2016. I commend multisectoral approaches in the implementation of NTD programmes, long-term strategies for NTDs, data use and everyone involved in making this happen. health system strengthening. Partnerships and country ownership are crucial in addressing neglected We call on our African leaders to commit to increased domestic funding, country ownership and sustainability of NTD tropical diseases (NTDs). These diseases affect the poorest and most 4 interventions. vulnerable people, and it is imperative that we ensure no one is left behind. As we start the new decade—with 2020 being a crucial year for NTDs—the momentum continues to grow. The Kigali All stakeholders have roles to play, and together we can transform millions of NTD Summit in June 2020 will set the global agenda and action needed for the eradication, elimination and lives. control of NTDs in line with the 2030 SDG targets, and will provide an important milestone to demonstrate Africans’ By leveraging the strengths of member states, nongovernmental organisations, ability to incite change in their communities for an Africa free of NTDs once and for all. Together, we are moving closer private companies, researchers, local communities and health care to bridging the gaps and reducing the burden of NTDs in Africa. Therefore, we call on world leaders, governments, the programmes, ESPEN is delivering impactful and sustainable action in the fight private sector and communities to pledge their support and dedicate their efforts to the fight against NTDs. Together, against NTDs. we can and we must fight and defeat this problem. Obviously, there is still much to be done, but with persistent, powerful, effective and efficient collaboration, including strong partnerships, we will triumph in conquering Achieving our common vision of an Africa free of NTDs requires concerted NTDs in Africa. Join us as we stand up and speak out against neglected tropical diseases! efforts in critical areas. We need political commitment and investment to ensure health systems are resilient. In doing so, we can accelerate momentum NTD Programme Managers, Africa towards attaining universal health coverage and beating NTDs. With the launch of the World NTD Roadmap 2021–2030, 2020 is a milestone year for NTDs. As such, this annual report is a timely review of our progress and will inform the actions that lie ahead. I would like to thank our partners, countries and programme managers who champion ESPEN’s work daily in countries, districts and communities. I look forward to our continued collaboration towards achieving universal health coverage and an Africa free of NTDs. Dr. Matshidiso Moeti WHO Regional Director for Africa AIDS Acquired immunodeficiency syndrome INCAS Institution-based Network on China-Africa SAFE strategy Surgery for TT, antibiotics to clear bacterial CAR Central African Republic Collaboration on Schistosomiasis infection, facial cleanliness and environmental improvement CIND Country integrated NTD database IUs Implementation units SCH Schistosomiasis DALYs Disability-adjusted life years JAP Joint Application Package SCM Supply chain management DBS Dried blood spot LF Lymphatic filariasis SDGs Sustainable Development Goals DEC Diethylcarbamazine LSHTM London School of Hygiene & Tropical Medicine SOP Standard operating procedures DRC Democratic Republic of the Congo MDA Mass drug administration STH Soil-transmitted helminthiasis DRG Trachoma Dossier Review Group MMDP Morbidity management and disability prevention STP São Tomé and Príncipe ELISA Enzyme-linked immunosorbent assay NGOs Nongovernmental organization TAS Transmission assessment surveys ESPEN Expanded Special Project for the Elimination of NPO National professional officer Neglected Tropical Diseases NTD Neglected tropical diseases TEC Trachoma Expert Committee FGS Female genital schistosomiasis OEM Onchocerciasis elimination mapping TIPAC Tool for Integrated Planning and Costing FTS Filariasis test strip ONCHO Onchocerciasis TIS Trachoma Impact Survey GET2020 Global Elimination of Trachoma 2020 meetings OTS Onchocerciasis Technical Advisory Subgroup TT Trachomatous trichiasis GIS Geographic information system PC-NTDs Neglected tropical diseases amenable to UN United Nations GPELF Global Programme to Eliminate Lymphatic preventive chemotherapy USAID The United States Agency for International Filariasis PZQ Praziquantel Development GPW13 Thirteenth General Programme of Work RPRG Regional Programme Review Group for Preventive WHO-AFRO World Health Organization Regional Office HQ Headquarters Chemotherapy for Africa ICT Immunochromatographic test IDA Ivermectin, DEC, and Albendazole SCALE DOWN This year’s report at a glance the number of people requiring preventive chemotherapy • In 2019, ESPEN supported Mauritania to start developing its trachoma elimination dossier. • In December 2019, Malawi completed a dossier to validate the elimination of lymphatic filariasis as a public health problem. The dossier was submitted to ESPEN, which provided technical and financial support for this important milestone. An ad hoc This third annual report summarises the key achievements committee reviewed the dossier and was endorsed and validated by the WHO Regional Office for Africa, followed by the WHO HQ. that resulted from ESPEN’s support to countries in 2019. • In the Democratic Republic of the Congo, trachoma impact surveys were conducted in 18 districts. • 54 pre-transmission assessment surveys (pre-TAS) in six countries (Comoros, Democratic Republic of the Congo, Kenya, Nigeria, Sierra Leone and the United Republic of Tanzania) were conducted. SCALING UP: • As part of the entomological monitoring of onchocerciasis interventions, ESPEN Laboratory analysed 203,391 black flies Increased geographical coverage towards the achievement of 100% geographical coverage. trapped in Burkina Faso and Senegal. • To evaluate the performance of the Ov16 enzyme-linked immunosorbent assay (ELISA) serological test, a total of 3,586 dried SUPPORTED IMPLEMENTATION IN SOUTH SOUDAN: blood spots (DBS) from Burkina Faso and Guinea-Bissau were analysed at ESPEN Laboratory. OF MDA FOR THE 5 PC-NTDs • After conducting a high coverage mass drug administration consistently for six years through ESPEN support, Zimbabwe 187,490 147,138 conducted an impact assessment survey for schistosomiasis and soil-transmitted helminthiasis. The results showed a significant 26 countries school-age children school-aged-children reduction in the diseases’ prevalence at district and national levels. The prevalence of schistosomiasis reduced from 23.0% to 61,258,027 individuals targeted targeted treated 5.0%. The number of districts with prevalence of S. haematobium heavy infection intensity (≥50e/ml) >1% reduced from 48 to 12. 778 districts 78% overall While eight districts had prevalence of heavy infection intensities > 1% for S. mansoni at baseline survey, after six rounds of MDA, treatment elimination of S. mansoni as a public health problem has been achieved in all Zimbabwean districts. coverage SÃO TOMÉ AND PRINCIPE IMPLEMENTED STRENGTHEN INFORMATION SYSTEMS TRIPLE THERAPY FOR LF FOR THE FIRST 75% for evidence-based decision-making TIME WHO-recommended minimum threshold • ESPEN conducted country data support missions in 17 countries. 7 implementation units • Using the outcomes of the country support missions, ESPEN developed a workbook to project preventive chemotherapy 148,460 people treated 9 interventions required in each implementation unit for the next five years. This tool is a resource available to country NTD 272% epidemiological coverage programmes to support data-driven decision-making over the next 10 years. • The ESPEN Portal, launched in 2017, now has 3,508 maps, as well as underlying datasets for all NTDs amenable to preventive LF, SCH, STH, ONCHO, TRACHOMA MAPPING IN THE SPIRIT OF LEAVING NO ONE chemotherapy (PC-NTDs). AND CONFIRMATORY MAPPING IN BEHIND, A HIGH-LEVEL MEETING 8 • 9,255 users from 153 countries (51 of them in Africa) visited the ESPEN Portal during 19,362 sessions. 309 implementation units in ON ONCHOCERCIASIS IN AREAS • During the reporting period, 1,615 surveys from eight countries used the ESPEN Collect platform. CO-ENDEMIC FOR LOIASIS WAS 9 countries ORGANISED, Regional and international experts IMPROVE THE EFFECTIVE USE OF DONATED MEDICINES PRELIMINARY INVESTIGATIONS identified several strategies that could through enhanced supply chain management in Angola, Botswana, and Namibia facilitate the implementation of mass • ESPEN conducted supply chain support missions in four countries (Cameroon, Mozambique, Niger and Rwanda). were conducted to establish endemicity status • Through the supply chain support missions and Joint Application Package (JAP) review, a total of 236,427,988 tablets were for trachoma, with tailored recommendations for drug administration in areas not currently mapping in 2020. eligible for it. saved, with an estimated worth of US $18,554,266. • ESPEN provided technical support and guidance to improve the supply chain, make the best use of NTD donated SUBNATIONAL ANALYSIS OF SCH MAPPING A TRAINING FOCUSED ON BUILDING medicines, and increase the timeliness and accuracy of data in country JAP applications. By the end of 2019, 45 JAPs DATA TO OPTIMISE MDA WAS CONDUCTED IN IN-COUNTRY CAPACITY WAS were reviewed, of which 24 were cleared. 22 COUNTRIES PROVIDED IN VARIOUS AREAS, 1.4 million school-age-children for more than PARTNERSHIPS were missing treatment, while 700 individuals. for coordination and resource mobilisation • ESPEN mobilised eight major donors, including the US Agency for International Development (USAID), MSD, Germany, 5.5 million tablets UK Department for International Development (DFID), Japan Ministry of Health, Korea International Cooperation Agency of praziquantel were distributed in areas where they (KOICA), Swiss Agency for Development and Cooperation (SDC), and the Bill & Melinda Gates Foundation. were not needed. • All eight provided US $31.5 million in catalytic funding for ESPEN over a period of four years. • ESPEN brought programme managers and their partners together in Addis in June 2019. • ESPEN and the Regional NTD Programme gathered almost 300 participants, including representatives from the WHO HQ and WHO-AFRO, RPRG members, programme managers from ministries of health, country NPOs, and partners, for the Second National Programme Managers meeting ABOUT ESPEN

BOX 1 BOX OUR VISION AFRICAN PEOPLE The World Health Organization (WHO) launched FREE OF NTDs The Expanded Special Project for the Elimination of Neglected Tropical Diseases OUR MISSION (ESPEN) in 2016 as one of WHO-AFRO’s flagship TO ACCELERATE THE projects to help African countries reduce the ELIMINATION OF NTDS burden of neglected tropical diseases. TO PROTECT 600 MILLION PEOPLE OF AFRICA Established in the spirit of partnership between endemic African countries, ESPEN works to reduce the burden of NTDs and remain on track to control and eliminate the five NTDs amenable to preventive chemotherapy: onchocerciasis, lymphatic filariasis (LF), schistosomiasis (SCH), soil-transmitted helminthiasis (STH) and trachoma. 11 ESPEN’s core team, based at WHO-AFRO in Brazzaville, focuses on evidence-based decision-making towards the control and elimination of NTDs. In line with the WHO’s 3 mission, ESPEN provides leadership on NTD matters by working with the member THE NEW WHO AFRICAN states and in collaboration with partners; supports evidence-based policy options by providing technical support, catalysing change and building sustainable institutional REGION ORGANIZATIONAL CHART 10 capacity; shapes the research agenda and stimulates the generation, translation ESPEN is under Universal Health Coverage/Communicable & Non-Communicable Diseases (UHC/UNC) Cluster. and dissemination of valuable knowledge; and monitors NTD elimination progress and trends. Facilitating country ownership and leadership of NTD programmes and WHO Headquarters contributing to the broader WHO targets of long-term health systems strengthening are COR-NTD deeply embedded within ESPEN’s core functions. ESPEN was established in the spirit of mutual accountability and trust, where partners support each other to execute an WHO-AFRO Regional Director NNN recommendations aligned set of activities to achieve shared goals. Pharmaceutical ESPEN works with governments, United Nations agencies, global and regional partners, Director of Programme Management partners nongovernmental organisations, and the private sector. This alliance has led to the scaling up of NTD interventions, and the prevention and reduction of illness and death Director of the UHC/Communicable and Steering Committee Non-Communicable Diseases Cluster from the five NTDs amenable to preventive chemotherapy. With the global community increasingly committing to the fight against NTDs, including research and development, Tropical and vector-borne Diseases Team we are in a better position than ever before to reduce the NTD burden using proven polices and strategies of prevention, treatment and elimination. But as far as we have strategic advice collaboration Technical partners come, there is still much to be done. ESPEN technical advice capacity & consultant pool At ESPEN, our mission is to support member states to accelerate the elimination of PC-NTDs to protect the 600 million people of Africa. This report describes the 2019 WHO Country Offices annual performance of ESPEN, emphasising key achievements. PC-NTD Regional operational support requests, work programmes Programme Review Group (PC-NTD RPRG) Member States COUNTRY-OWNED INITIATIVE Countries strengthen their health system and build an integrated, tailored approach, leading the effort to reach NTD elimination with supported countries the support of partners 26 Mass drug administrations TRANSPARENCY 22 Data analyses for optimisation of MDA against SCH Timely information sharing FIG. 1 19 Data and supply chain missions PARTNERSHIP 18 Mapping and impact surveys We are a group of like-minded partners form both public and core private sectors fighting for the elimination of NTDs in Africa LEADERSHIP values As a part of WHO-AFRO, ESPEN stands ready to provide technical expertise to countries and partners Algeria EGYPT

VALUE FOR MONEY • Economy: Quality interventions at a minimal cost MAURITANIA MALI NIGER • Effectiveness: Flexible and able to adapt to a changing environment SUDAN ERITREA SENEGAL CHAD YEMEN • Efficiency: Quality data for smarter decision-making GAMBIA BURKINA FASO GUINEA BISSAU DJIBOUTI • Equity: Access to NTD services to all partners GUINEA BENIN NIGERIA SOMALIA SIERRA LEONE GHANA ETHIOPIA CÔTE D’IVOIRE TOGO CAR SOUTH SUDAN LIBERIA CAMEROON

FIG. 2 EQUATORIAL GUINEA UGANDA CONGO KENYA 13 GABON DRC RWANDA BURUNDI

OBJECTIVES TANZANIA 12 SCALING UP EFFECTIVE USE OF ANGOLA MOZAMBIQUE FIG.3 ZAMBIA Increasing geographical DONATED MEDICINES MALAWI Number of activities coverage among populations Improve effective use of supported in 2019 ZIMBABWE requiring treatment. NAMIBIA MADAGASCAR donated medicines through BOTSWANA enhanced supply chain 0 (8) 1 (18) management. EsWATINI 2 (15) LESOTHO SOUTH AFRICA SCALING DOWN STRENGTHENING 3 (10) INFORMATION SYSTEMS 4 (2) Reducing the number of people Strengthening information SAO TOME requiring preventive systems for evidence-based CAPE VERDE comoros EQUATORIAL GUINEA mauritius & Principe Seychelles TANZANIA chemotherapy. decision-making. Pemba Zanzibar

PARTNERSHIP RESOURCE MOBILIZATION

Effective partnership Strategic advocacy, Disclaimer: The boundaries and names shown and the designations used on this map to not imply the expression and coordination with communication and resource of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, countries and key mobilisation. territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and stakeholders. dashed lines on maps represent approximate border lines for which there may not yet be full agreement. INTRODUCTION

This is the third ESPEN annual report since the project launched in 2016. It includes a summary of the major accomplishments of ESPEN in the control and elimination of NTDs in ESPEN’s mandate countries in 2019. HOW PROGRESS IN REDUCING NTDS ESPEN’s work is in line with SDG Target 3.3 to end the epidemics of AIDS, , malaria and neglected tropical CONTRIBUTES TO ACHIEVING THE SDGs. diseases by 2030. The indicator that tracks the progress against Target 3.3.5 is the number of people requiring interventions against neglected tropical diseases. Increased universal access to NTD prevention and treatment Sources: United Nations [2] and Bangert et al, 2017 [3] services for populations at risk will contribute to the attainment of SDG Goal 3.8, universal health coverage. Table 1 Table

The disabling and debilitating Controlling and eliminating NTDs can cause stigma and Availability of improved Reducing the burden of NTDs Inequality in disease 4effects of NTDs prevent NTDs contributes to improved reduce school attendance, water and sanitation has a significant impact prevalence across affected individuals from agricultural productivity, performance and cognitive services reduces the rate on individuals’ employment socioeconomic groups providing for their families increased food security and ability. Reducing NTDs of vector breeding and NTD prospects and, by extension, is a hallmark of NTDs. and contributing to the better nutritional status contributes to school transmission. NTD prevention national productivity. Interventions aimed at the economic development of for affected communities, attendance, improved 15 efforts such as environmental Interventions to control most disadvantaged and their countries and generate a particularly women and performance and cognitive management and use of NTDs promise significant marginalised populations significant care burden. At the children. Sustained investment ability. In later years, it will sanitation facilities can economic payoffs outside the reduce this inequality and help household level, this results in in NTD control and elimination also contribute to better wage- contribute to further health health sector—in agricultural make sure that no one is left generations becoming trapped contributes to the safety earning capacity. benefits. productivity and educational behind. in a cycle of increased medical and quality of food and 14 benefits—so should be costs, poverty and disease. an increased return on considered as investments in Investing in NTD control and investment. human capital and economic elimination increases human growth. capital and contributes to growth. By preventing the development of disease, NTD programmes reduce exposure to the debilitating physical and mental health effects of While NTDs impose a heavy Sustainable energy strategies Building sustainable and NTDs and reduce the financial burden on both sexes, there that integrate rural energy needs resilient cities reduces the burdens that are brought on has been increased recognition offer considerable opportunities burden of NTDs through better when households are forced of the disproportionate impact for the long-term control of access to water and sanitation, to seek medical care and lose Scaling up NTD interventions of some NTDs on the health parasitic diseases and improved improved housing, and reduced earnings. By reducing the impact contributes to the achievement quality of life. The electrification breeding of vectors. Improved of girls and women. Women of infrastructure and of universal health coverage. of NTD endemic areas means infrastructure increases and girls who are free from industrial development on Preventing NTDs reduces people spend more time indoors, access to NTD interventions. NTDs and the burden of caring the transmission of NTDs, morbidity, disability and where vectors can be controlled Actively removing breeding for family members with the benefits of development mortality. Reducing the through the use of bed nets and sites through community- NTDs experience increased can be harnessed. Research burden of NTDs contributes insecticides. It also means people based interventions ensures school completion rates, more and innovation can help significantly to improved child have enough energy to cook foods cities are resilient to vector participation in decision- produce new interventions for health and development. and reduce the consumption of raw breeding threats. making and more participation eliminating NTDs. in the workforce. foods. Sustainable and affordable energy infrastructure development will likely result in reducing the burden of NTDs. The WHO triple billion targets and the contribution of NTD

Chemicals are frequently Deforestation leads to the The strong, inclusive, global, used to combat mosquitos, proliferation of vector-borne multisectoral partnerships which are responsible for diseases, affecting people formed to control and control and elimination the transmission of NTDs. who work or live near forests. eliminate NTDs can have a The sustainable use and Active vector control and positive effect on humanitarian management of chemicals is providing educational services development. Public–private ensured through continued to affected communities can partnerships for NTD pesticide safety and efficacy mitigate the impact of disease interventions have been critical evaluation. vector proliferation. and effective. In 2015 alone, Un pharmaceutical companies ive ies rs FIG. 4 donated an estimated 2.4 nc al e H The WHO Triple Billion billion tablets, to prevent and g e r a treat NTDs, enough for 1.5 e l targets and the m t billion treatments. Experience h E 1 1 C contribution of NTD gained from working on these h t BILLION MORE BILLION MORE o partnerships can be used to l v control and elimination. a PEOPLE PEOPLE e build partnerships for other e BETTER PROTECTED BENEFITING FROM r H a The three intersected

SDG themes. FROM g

e targets in the GPW13 aim for one billion more people Vector-borne NTD epidemics 17 benefiting from Universal and transmission rates Health Coverage; one increase with climate change. NTD epidemics frequently 1 Efforts to mitigate the effects occur during times of war billion more people better and crisis. Advocating for BILLION MORE of climate change will help in PEOPLE ENJOYING protected from health the elimination and control of interventions for affected 16 emergencies; and one billion populations in times of crisis NTDs, and working to control B more people enjoying better NTDs will help in stopping can be used as a tool to et ng health and well-being. promote peace. Investment in te ei climate change. r H ll-B NTDs contributes to inclusive ealth and We Source: WHO (2018) [1]. societies.

ACHIEVING UNIVERSAL ADDRESSING PROMOTING HEALTH COVERAGE HEALTH EMERGENCIES HEALTHIER POPULATIONS

ESPEN supports countries ESPEN works with countries ESPEN works with ESPEN’s work also contributes to the WHO’s GPW13 [1] Triple Billion and partners in scaling up to improve access to NTD governments and partners Clean bodies of water are targets by scaling up NTD prevention and treatment services for the NTD prevention and treatment interventions in conflict- on interventions focusing important to maintain food 600 million African people at risk of NTDs and contributing to the security and good sanitation. services through propor affected areas and help on preventing and treating attainment of universal health coverage. Furthermore, by preventing NTD interventions such as approach to create access for mitigate the impact of disability, stigma and water treatment programs disability, stigma and associated mental illness due to NTDs, ESPEN 600 million African people at health emergencies on the attendant mental illness due and educational services contributes to an increased number of people enjoying an improved risk of NTDs and contribute to population. to NTDs, and contributes to for affected communities quality of life. By improving access to NTD interventions in conflict- attainment of Universal Health more people enjoying better can address the problem of affected countries, ESPEN helps mitigate the impact of health Coverage. health and well-being. contaminated water. emergencies on populations. Significant progress has been achieved globally in the fight against NTDs since the launch of the WHO Roadmap on NTDs in 2012 and the London Declaration. NTDs are a group of Of the 52 ESPEN-supported countries, Highlights include the elimination of lymphatic Neglected 50 are endemic for at least one filariasis as a public health problem in 17 diseases that primarily countries, including Egypt, Malawi, Togo and affect the poor and most PC-NTD, with an estimated Yemen, which are under ESPEN’s mandate, and 600 million million people requiring preventive the elimination of trachoma as a public health Tropical marginalised communities chemotherapy. problem in nine countries, including Ghana, Diseases in the world. which is under ESPEN’s mandate.

Algeria in Africa EGYPT

Globally, there are 1.76 billion people requiring preventive chemotherapy for MAURITANIA MALI NIGER NTDs[4, 5]. NTDs lead to long-term disability and economic loss for affected SUDAN ERITREA individuals and families, who suffer from disfigurement, impaired childhood SENEGAL CHAD YEMEN GAMBIA BURKINA FASO growth and development, adverse outcomes, and reduced productive GUINEA BISSAU DJIBOUTI GUINEA BENIN capacity. A study estimated that achieving the target of controlling and NIGERIA SOMALIA SIERRA LEONE GHANA ETHIOPIA CÔTE D’IVOIRE TOGO eliminating the five PC-NTDs will lead to $564 billion in productivity gains and CAR SOUTH SUDAN 5 LIBERIA result in 328 million averted disability-adjusted life years (DALYs) worldwide [6]. CAMEROON

For every $1 invested in fighting NTDs, there are $27 to $42 in economic benefits EQUATORIAL GUINEA UGANDA CONGO KENYA [6]. This makes NTD investments one of the “best buys” for health [6]. Although 19 GABON DRC RWANDA Africa is home to only 17% of the world’s population, it carries 39% of the BURUNDI global burden of NTDs—the largest worldwide. [7] A total of 44 African nations TANZANIA are endemic for at least one PC-NTD and 42 countries are endemic for at least two. 18 FIG. 5 ANGOLA MOZAMBIQUE Despite the high morbidity burden of these diseases, they’ve received little Number of NTDs ZAMBIA MALAWI attention internationally and have been disregarded for a long time, with no requiring PC tools or strategies being developed to overcome them [8]. The publication of the ZIMBABWE 0 - ( 2 ) NAMIBIA MADAGASCAR WHO Roadmap on NTDs and the London Declaration in 2012 changed the global BOTSWANA landscape and architecture of NTD interventions, particularly for the five most 1 - ( 4 )

prevalent NTDs: LF, ONCHO, SCH, STH and trachoma [8, 9]. 2 - ( 8 ) EsWATINI 3 - ( 7 ) Since 2012, significant progress has been made in Africa, notably the scale-up of LESOTHO SOUTH AFRICA mass drug administration for the five PC-NTDs. Following the launch of the WHO 4 - ( 17 ) Roadmap on NTDs, there was an unprecedented increase in capacity of MDA for 5 - ( 15 ) LF, schistosomiasis, STH and trachoma through ESPEN and partners’ support. The use of MDA to deliver preventive chemotherapy has had the greatest impact on SAO TOME CAPE VERDE comoros EQUATORIAL GUINEA mauritius & Principe Seychelles TANZANIA those at risk for NTDs and the NTD programme in general. The unique approach of its delivery mobilised the global community, including the pharmaceutical industry. The approach empowered communities and created an important health delivery system that can be integrated with other interventions.

Disclaimer: The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. 1.2. INTRODUCTION LF, more commonly known as elephantiasis, is a painful, debilitating and disfiguring disease caused by infection from parasitic worms and transmitted by mosquitos [10]. In 2019, 33 ESPEN-supported countries were considered endemic for LF and either requiring MDA or under surveillance to validate whether elimination targets had been achieved. Of these countries, Cameroon and Malawi have stopped MDA in all endemic districts and are under surveillance. In 2019, MDA was required in 31 countries in at least one implementation unit, with an estimated 341 million people requiring MDA. To meet the elimination target, MDA must be delivered in every endemic implementation unit. Of the 31 countries, 23 have conducted MDA in all endemic implementation units, with at least one round of Lymphatic MDA reaching 100% geographical coverage. In six countries, MDA has not been implemented yet in all endemic implementation units. Two countries (Equatorial Guinea and Gabon) have not started MDA. ESPEN will provide financial support to start MDA in these two countries, and they are planning to launch LF MDA in 2020. filariasis 1.3. MAPPING As of the beginning of 2019, all LF-endemic countries in the region were mapped and only three (Central African Republic, Equatorial Guinea and South Sudan) had mapping gaps due to security issues. In 2019, ESPEN supported mapping and confirmatory mapping of LF in 139 implementation units in five countries 21 (Angola, Central African Republic, Kenya, Madagascar and South Sudan). 6 1.1. SUMMARY Confirmatory mapping inMadagascar is supported in 32 implementation units. Although mapping was done in 2001 in Madagascar, for various reasons there was no MDA in these 32 IUs. Because of this, coupled with a very low prevalence of LF in the mapped IUs, confirmatory mapping was conducted ESPEN’s major achievements in LF control in 2019 include: 20 in districts with a prevalence of 1% or greater in 2019. As of the end of 2019, mapping of LF has been • ESPEN supported eight countries (Comoros, Democratic Republic of completed in almost all AFRO countries except a district in Equatorial Guinea (Annonbon), which is not yet the Congo, Equatorial Guinea, Eritrea, Republic of Congo, Nigeria, mapped due to inaccessibility. ESPEN supported countries with financial, technical and logistical support, Madagascar, and São Tomé and Príncipe) for LF MDA targeting as well as the procurement and distribution of filariasis test strips (FTS) and positive controls, in order to 18,009,135 individuals in 136 implementation units. All of them complete the mapping. received treatment. Mapping of LF using a standard methodology (i.e., selecting two villages per implementation unit and • Of the eight ESPEN-supported countries, at least four achieved 100% testing 100 individuals using an immunochromatographic test (ICT) or FTS) was conducted in Angola in geographical coverage for LF MDA in 2019. 2015. Angola is endemic for loiasis, and studies have confirmed the presence of cross-reactivity between ICT LF positivity and loiasis/mansonellosis presence. This means that people with loiasis could show false- • Malawi completed and submitted an elimination dossier in December positive results for LF when ICTs are used. Due to this discovery during the mapping in 2015, night blood 2019 to validate the elimination of LF as a public health problem smears and dry blood spots were collected for further analysis from those individuals who tested positive in the country. ESPEN supported the development of the dossier for LF using an ICT and residing in loiasis endemic districts. by providing technical and financial support and then identified independent reviewers. The dossier was reviewed and endorsed by In July 2019, ESPEN sent a team to support SCH and STH mapping in Angola. While in the field, the team WHO-AFRO and submitted to WHO HQ for validation. In 2020, WHO HQ read 4,074 blood smear slides that had been collected and fixed during the 2015/2016 mapping. The team validated the elimination of LF in Malawi as a public health problem. found no LF-causing parasites in the blood smear slides but instead found parasites for loiasis and Mansonella perstans. Therefore, ESPEN is working to provide guidance on the endemicity of LF in Angola • A triple drug therapy known as IDA, containing diethylcarbamizine based on the ICT results and night blood smear reading results. (DEC), albendazole (ALB) and ivermectin (IVM) has been scaled up to 100% geographical coverage in São Tomé and Príncipe.

1_Benin, Burkina Faso, Chad, Comoros, Congo, Côte d’Ivoire, Eritrea, Ethiopia, Ghana, Guinea, Guinea-Bissau, Kenya, Liberia, Mali, Mozambique, Niger, Senegal, São Tomé and Príncipe, Sierra Leone, Uganda, United Republic of Tanzania, Zambia and Zimbabwe. 2_Angola, Central African Republic, Democratic Republic of the Congo, Madagascar, Nigeria and South Sudan BOX 2 Support fortheimplementationofIDA (seeBox 2). further validated withacoverage surveythatindicated74%coverage. ESPEN provided technicalandfinancial. coverage.epidemiological Allthetreated implementationunitsachieved effective coverage. Theresults were was implementedinseven implementationunits,andatotalof148,460peoplewere treated, reaching 72% ESPEN supportedtheimplementationofivermectin, DEC andalbendazole(IDA) inSãoTomé andPríncipe. IDA was notstarted in2019.Itisscheduledforearly2020andpostponedagainduetotheCOVID-19 crisis. treatment usingalbendazoletwiceayear was advisedforthesetwo problems, MDA countries.Duetologistical Therefore, itwas notpossible totreat thecommunitywithivermectin. Inlinewiththeglobalrecommendation, for onchocerciasis andloiasis,thesurveyconducted in2015-2016alsoconfirmedtheendemicityofLF. implement MDA. Equatorial In 2019,fourendemiccountriesinAfrica (EquatorialGuinea, Mass drugadministration SCALING UP MASS DRUG ADMINISTRATION Zimbabwe would like to assess thecurrent statusofthediseasebefore restarting. in 2018and2019. ESPEN isadvocating forrestarting thetreatment usingtheIDA regimen, but treatment coverage in2016and 2017 respectively. Nonetheless, discontinuedMDA thecountry coverage of100%usingthetwo-drug achieved regimen. Thecountry 78.6%and48.3% implementation units.In2016and2017, LF MDA was conducted there, withageographical MDA withDA andwas forIDA foundtobenoneligible atthisstage. Zimbabwe has 39endemic mission ontheimportanceofIDA in2020.Zambia has hadmore thanthree effective rounds of is plannedfor2020andtherollout ofIDA isscheduledfor2021. ESPEN willorganise anadvocacy Comoros willbeimplementingatwo-drug therapy in2020.Thetransmission assessment survey Eritrea andMadagascar. with acoverage survey thatindicated74% coverage. In2020,therollout ofIDA isplannedin treated implementationunitsachieved effective coverage. Theresults were furthervalidated units, andatotalof148,460peoplewere coverage. treated with72%epidemiological Allthe of greater than80%.In2019,São Tomé andPríncipeimplementedIDA in seven implementation individuals andtreated 252,930by theendof2018.Allthree sub-counties achieved coverage implement IDA inAfrica, hadimplementedIDA inthree sub-countiestargeting 278,291 Madagascar, SãoTomé andPríncipe, Zambia, andZimbabwe. Kenya, to thefirstcountry identified seven forIDA: countriesonthecontinenteligible Comoros, Eritrea, Kenya, In May 2018,theWHOconvened atechnicalmeeting inNairobi onIDA inAfrica. Themeeting reduce thetimetotreat andbreak thetransmission ofLF. administration toeliminatelymphaticfilariasis.”IDA regimen treatment hasthepotentialto two-drug regimen. Subsequently, theWHOpublishedaguidelinecalled“Alternative mass drug The studiesalsofoundthatitclearsmicrofilaria more efficiently fromthebloodthan co-endemic withLFasthetwo-drug (DEC regimen andalbendazole)thatisusedduringMDA. of ivermectin, DEC andalbendazole, known asIDA, isassafewhere onchocerciasis isnot In 2017, large randomised communitystudiesinfourcountriesfoundthatthecombination ELIMINATION OFLYMPHATIC FILARIASIS SCALING UP TRIPLETHERAPY INAFRICA TO ACCELERATE THE Guinea andGabonhave stillnotstartedMDA. Thesecountriesare co-endemic Gabon, ) did not Zambia andZimbabwe) didnot 22 23 West andFHI360.Thematerial isavailable onlineat https://fhi360.adobeconnect.com/puthxfpwi55c webinars ontransmission assessment surveybestpractices, whichwere organised by USAID’s Act toEndNTDs experiences inKenya andSãoTomé and Príncipewere shared. ESPEN staffcontributed tothedevelopment of ESPEN contributedtotheGlobalIDA meeting inBangkok, Thailand,inJuly2019,where IDA implementation participating intechnicalmeetings. for LFelimination, ESPEN played animportantrole andgloballevels attheregional fortheeliminationofLFby programme inKenya support ontheimplementationmodalitiesofLF programme. Inaddition tocountry ESPEN provided technicalsupportforIDA implementationinSãoTomé andPríncipe andguidedtheLF 1.5. TECHNICAL SUPPORT ANDLEADERSHIP • DRUG ADMINISTRATION 1.4. SCALE DOWN: REDUCING INFECTIONANDDISCONTINUING MASS management. As oftheend2019,allAFROLF-endemic countriesare trained onMMDP. Congo andensure MMDP) toscaleuptheinterventions access. Training focusedonlymphoedemaandhydrocele Chad, officers andNTDmanagers from eightcountriesthatdidn’t receive training the previous year(Angola, In additiontotraining LF-endemic countriesonMMDP in2018,2019ESPEN provided training onMMDP toLF with LFmorbidityshouldbeprovided withaccess tobasiccare forLF-related morbiditiesinLFendemicareas. MMDP isthesecondpillarofWHO’s GlobalProgramme People toEliminateLymphaticFilariasis(GPELF)[12]. Scaling upmorbiditymanagementanddisabilityprevention (MMDP) • countries (Comoros, been sustainedbelow eliminationthresholds afterMDA. In2019,ESPEN supported54pre-TAS insix be passed. TAS isimplementedtodecidewhether tostopMDA by confirming whether theinfection has known aspre-TAS) communitiesconsidered athighrisk;andLFtransmission assessment surveys should should bereduced tobelow 1%microfilaraemia or2%antigenemiainsentinelandspot-check(also Transmission assessment surveys (TAS) andpre-TAS: Before stoppingMDA, theprevalence ofinfection for eliminatingLFasapublichealthproblem. mustensure access[18]. Thecountry toMMDP andsurveillance, anditmustprepare adossier to bevalidated isstillnotvalidated aseliminatingLFapublichealthproblem as nonendemicforLFin2015,thecountry mosquito densitythrough thewidespread useofinsecticidal nets. AlthoughThe Gambiahasbeenreclassified robust andvalidated tool”[17].Thestudiesattributed thedeclineinprevalence toasignificant reduction in confirming the absence of transmission of LF in all 21 districts surveyed using WHO-recommended statistically transmission interruptionofLFinTheGambia[17].studyconcludedthat“our results are unequivocal in in theabsenceofMDA [16].Arobust studyconducted in2013usingtheTAS methodology confirmedthe Nonetheless, different surveys conducted in1975and1976revealed asignificantdeclineinLFendemicity that theprevalence ofLFinfection inTheGambiawas amongthehighestinAfrica inthe1950s[14,15]. elimination, ESPEN isalsosupportingcountries inthepreparation ofthedossier. Studieshave documented for validation. Validation was signedby WHOinthefirstquarterof2020. As countries progress towards Validation process: Malawi’s dossier was reviewed andendorsedby WHO-AFROandsubmittedtoWHO-HQ implemented thesurveys. survey requests in2019.Theteamreviewed 81 TAS andprovided feedbackforfive countriesbefore they of thesurveys. SincetheRPRGisunderrestructuring, theESPEN teamhasreviewed andapproved Programme Review Group forPreventive Chemotherapy (RPRG)togoaheadwiththeimplementation set standards of quality. Before conducting TAS, countriesare required toget approval from theRegional Republic ofTanzania). ESPEN provided financial andtechnicalsupportforthesurveys toensure they met Central African Republic, Democratic RepublicoftheCongo, Democratic RepublicoftheCongo, Kenya, Equatorial Nigeria, Republic of Guinea andtheRepublicof Sierra Leone andtheUnited Comoros,

1.2. INTRODUCTION Onchocerciasis is caused by the parasitic worm Onchocerca volvulus [19]. It is commonly called «river blindness» because the parasite is transmitted through the repeated bites of black flies of the genus Simulium, which breed along rivers and streams in areas where there is fast-moving water and because the infection can result in vision loss and blindness [20]. Among ESPEN mandate countries, 32 are endemic for onchocerciasis, with more than 227 million people at risk. Of these, four countries (Kenya, Mozambique, Niger and Rwanda) are not considered to require preventive chemotherapy. Nonetheless, these countries need to conduct onchocerciasis elimination mapping (OEM) to demonstrate no active transmission in areas never exposed to ivermectin treatment where transmission of ONCHO is not considered unsuitable. In 2019, MDA was required in 28 of ESPEN’s mandate countries. Three countries (Ethiopia, Nigeria and Uganda) stopped MDA in at least one subnational area after meeting the criteria of the 2016 WHO guidelines and started post-treatment surveillance Onchocerciasis [20]. 1.3. MAPPING In 2009, the target for the onchocerciasis programme began to shift from control to elimination [19]. Subnational achievements in some African countries have demonstrated that annual or semi-annual MDA could break transmission and lead to elimination. As a result, there was a shift of focus from controlling morbidity to interrupting transmission of onchocerciasis [19]. This has required the global programme for the elimination of onchocerciasis to address several longstanding challenges. To achieve 1.1. SUMMARY elimination throughout ESPEN mandate countries, all areas not currently under ivermectin treatment where transmission of ONCHO is ongoing must be identified and treatment guaranteed. Under the previous ESPEN’s major achievements in onchocerciasis control in 25 control strategy, foci with moderate to high levels of transmission were targeted for treatment. Areas 7 2019 include: with low-prevalence settings were not included in the interventions. To address this gap, ESPEN initiated onchocerciasis elimination mapping. In 2019, ESPEN supported the scale-up of OEM through capacity • ESPEN supported MDA in five countries Burundi,( Democratic building in 11 countries (Chad, Côte d’Ivoire, Democratic Republic of the Congo, Ethiopia, Equatorial Republic of the Congo, Malawi, Republic of Congo and Yemen) 24 Guinea, Kenya, Mali, Nigeria, Republic of Congo, Sudan and Senegal). Training was provided to experts targeting 9,520,171 people in 99 implementation units. Yemen from these countries for five days inBrazzaville , Republic of Congo. OEM mapping was conducted in 19 treated more than half a million people for onchocerciasis in 33 implementation units in Equatorial Guinea. In all the trained countries, OEM will be scaled up in 2020, districts despite civil unrest. although this activity may be delayed due to the ongoing COVID-19 crisis. • ESPEN built capacity to scale up onchocerciasis elimination mapping in 11 countries (Chad, Côte d’Ivoire, Democratic Republic of the Congo, Ethiopia, Equatorial Guinea, Kenya, Mali, Nigeria, 1.4. SCALE UP MASS DRUG ADMINISTRATION Republic of Congo, Sudan and Senegal). In 2019, ESPEN supported MDA in five countries Burundi( , Democratic Republic of the Congo, Malawi, • In support of scaling up MDA and ensuring no onchocerciasis- Republic of Congo and Yemen) targeting 9,520,171 people from 99 districts. Through ESPEN support, endemic district is left behind, in June 2019 ESPEN organised a Yemen conducted MDA in 33 districts of its eight governorates in January 2019. This MDA campaign policy dialogue on onchocerciasis in areas co- endemic for loiasis. was led by the Yemen Ministry of Public Health and the WHO. Of the 528,420 people targeted in all eight governorates, 474,027 were reached and treated, achieving 90% treatment coverage. A total of 1,177,524 • An onchocerciasis breeding site assessment was conducted in the ivermectin tablets from the Mectizan Donation Programme were distributed during the campaign. northwest and southeast regions of Liberia. In June 2019, ESPEN hosted a meeting on onchocerciasis in areas co-endemic for loiasis. The 29 • ESPEN Laboratory analysed 203,391 black flies trapped inBurkina regional and international experts in attendance identified several strategies that could facilitate the Faso and Senegal. implementation of MDA in those areas not currently eligible for MDA. The experts identified important • As part of the evaluation of the performance of the Ov16 ELISA operational research to help develop recommendations for their use in programmes. (See Box 3.). serological test, a total of 3,586 dried blood spots from Burkina Faso and Guinea-Bissau were analysed at the ESPEN Laboratory. 1_ Angola, Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Congo, Côte d’Ivoire, Democratic Republic of the Congo, Equatorial Guinea, Ethiopia, Gabon, Ghana, Guinea, Guinea-Bissau, Liberia, Malawi, Mali, Niger, Senegal, Sierra Leone, South Sudan, Sudan, Togo, Uganda, United Republic of Tanzania, Yemen. BOX 3 The expertsalsoidentifiedseveral operational research questionstotestthe recommendations. identified numerous of approaches thatcouldenablethedelivery MDA inthoseareas notcurrently qualifiedfor MDA. to proceed, includingthetypeandlevel ofinputfrom affected andinternationalexperts communities.Theregional associated seriousadverse events; andthemostappropriate decision-makingprocess toallow theMDA campaigns therolesstrategies; andspecificaccountabilitiesofeachpartnerorganisation forivermectin-based MDA and of scenariosthatemploy approaches different andrisk-mitigation combinationsofdiagnostictools;epidemiologic co-endemic areas; currentforreducing toolsandstrategies therisk ofmore severe adverse events; theimplications The participantsdiscussed thegapsinunderstandingoverlap ofonchocerciasis andloiasis;theriskofSAEs in seven NTDprogramme managersfrom theloiasisco-endemiccountriesinAfrican region. meeting tookplaceJune24-262019,inBrazzaville, RepublicofCongo, andwas attendedby 29experts,including for developing adecision-makingstrategy asafirststeptowards thecompletion ofacomprehensive strategy. The convened adiverse group ofstakeholders toreview theavailable aswell toolsandstrategies asdifferent options the bioethical implicationsofpotentialtreatmentinthissetting. strategies Inresponse tothatrequest, ESPEN The World HealthOrganization Onchocerciasis Technical Subgroup (OTS) Advisory recommended examining been started. distribute ivermectin safelyinareas co-endemicforriver blindness andloiasisbutwhere MDA programmes have not yearsfor 10-12 ormore. Becauseoftheriskdangerous sideeffects, anew strategy isneededinorder tobeable transmission andare co-endemicforloiasis.To eliminateonchocerciasis, MDA ofivermectin needstoberepeated mass treatment withivermectin inareas thathave littleonchocerciasis-associated morbiditybuthave ongoing One oftheseveral longstandingchallengesoftheonchocerciasis eliminationprogram hasbeenhow toimplement ENDEMIC AREAS WORLD HEALTH ORGANIZATION MEETING ONLOIASIS INONCHOCERCIASIS- parasite. Individualresults from Senegal andBurkina Faso are presented in Table 2. Infection was determined by aPCR-ELISAprocedure ofthe0-150 DNA repeats present intheO.volvulus flies trapped inSenegaland100,512 blackflies from BurkinaFaso . Thepoolscreening method was employed. participating inonchocerciasis activity was analysed conducted. In2019,theESPEN 102,879 black Laboratory bloodspotsby ELISA.As partofcapacitybuilding,training of technicians fromfrom countries eluteddry rates withtheOnchocerca volvulus parasite anddetection oftheIgG4antibody againstO.volvulus Ov-16 antigen mainlyfocusedontheanalysisIn 2019,theactivities oftheESPEN ofadultblackfliesforinfectivity Laboratory objectives: for informeddecision-makinginsupportofthisobjective. To hasthefollowing thisend,theESPEN Laboratory priority objective forESPEN. isparamount inproviding TheESPEN Laboratory data onchocerciasis surveillance Scaling down preventive chemotherapy onceinterruptionofdiseasetransmission hasbeenestablishedisa ESPEN Laboratory Liberia. As partofthevector foronchocerciasis, control abackflybreeding intervention siteassessment was conducted in ADMINISTRATION SCALE DOWN: REDUCING INFECTIONANDDISCONTINUING MASS DRUG • • • • • ELISA, OV 16RDT, KatoKatz,FTS, etc. Assisting reagents countries intheprocurement suchasOV16 andstorage ofdiagnosticsandlaboratory data use oflaboratory data fortheAfrican andsupportingcountriesontheanalysis region and oflaboratory Being arepository Analysing samplestosupportcountrieswhere nationallaboratories donothave sufficientcapacity Providing qualitycontrol and qualityassurance NTDlaboratory capacityinAfrica Enhancing NTDlaboratory 26 27 Table 2 for NTDs. surveillance forlaboratory site forkits,reagents andequipment forin-needcountriesandadatarepository diagnosis ofallneglected storage tropical diseases inAfrica. mayasanancillary ESPEN alsoserve Laboratory partners, ESPEN isplaying acentral role inestablishinganetwork ofnationallaboratories involved inthe United States(https://www.ntdsupport.org/resources/ntd-laboratory-coordinating-bureau-nlcb) andother Working closelywiththeTask very Force Coordinating forGlobalHealthNTDLaboratory Bureau (NLCB) inthe activities inWest activities, technology Africa toharmoniselaboratory transfers andthesharingofdata. ESPEN labestablishedcommunication withcoordinators ofcountriesparticipatinginonchocerciasis Ethiopia, Pemba/Zanziba. provided ESPEN Laboratory two facilitators.Intotal,there were 35participantsdrawn from capacityforthediagnosisofNTDsstrengthening in laboratory andwas heldatthePublicHealthLaboratory ofHealthZanzibar,UnitedRepublicTanzaniawith theMinistry . Theworkshop was geared towards participatedinacapacitybuildingworkshopthe ESPEN Laboratory organised by WHOHQincollaboration Onchocerciasis/Lymphatic inNiamey, FilariasisNationalLaboratory Niger,onpoolscreening. InJune2019, points ofNTDprogrammes trained fromtechnicians ofMali.TheESPEN the fourregions Laboratory In 2019,withthefinancialsupportofEnd Fund, atechnicianfromtrained thefocal theESPEN Laboratory training alsoequippedparticipantswithskillsinidentifying theSimuliumdamnosumcollection ofsamples. transmission zones,selecting first-linecommunitiesand,ultimately, determining vector collection sites.The transmission. Capacitybuildingtraining was provided toparticipantsonidentifyingbreeding sitemapsand Elimination ofonchocerciasis requires surveys robust entomological formonitoringprogress andinterrupting capacitybuilding Laboratory the useofOv-16 fordiagnosisofonchocerciasis inAfrica. 2,558 from Guinea-Bissau) were analysed in2019.Theresults attheESPEN obtainedsupported Laboratory in anAfrican labsetting. As partofthisevaluation, atotalof3,586DBSs (1,028 from BurkinaFaso and wasthe ESPEN involved Laboratory intheevaluation test oftheperformanceOv16ELISAserological relatively stableandcanbeeasilycollected andtransported toacentral facilityfortestinglater.Therefore, O. volvulus. MostOv16ELISAmethods utilisedriedbloodspotsastheinputsampletype. DBS samplesare The Ov16ELISAisrecommended by WHOguidelinesfordemonstrating theinterruptionoftransmission of Serology across theregion. Burkina Faso, ESPEN continued toplay animportantrole insupportingcountriesbuilding labcapacity provided subgroup. inOuagadougou, by theonchocerciasis Through technicaladvisory itslaboratory ESPEN conducted atechnical meeting ononchocerciasis eliminationmappingbasedontheguidance thatcouldfacilitatetheimplementationofMDAstrategies inthoseareas forMDA. notcurrently eligible onchocerciasis inareas co-endemicforloiasis,where andinternational expertsidentifiedseveral regional In 2019,ESPEN played animportantrole andgloballevels. attheregional ESPEN hostedameeting on 1.5. TECHNICAL INONCHOCERCIASIS SUPPORT ANDLEADERSHIP IN SENEGAL ANDBURKINAFASO 2019 POOLSCREENINGRESULTS OFSAMPLESCOLLECTED SENEGAL BURKINA FASO COUNTRIES Iran, Italy, River BasinsofComoé andVolta TRANSMISSION ZONE ZONE TRANSMISSION Kenya, River BasinsofGambie River BasinsofFalémé Somalia, South Sudan, NUMBER OF BLACK NUMBER OFBLACK FLIES ANALYSED Rwanda, Zanzibar andTanzania 100,512 55,508 47,371 INFECTIVITY RATE (10-3) 0.195476 0.0498 0.2997

mainland. INTERVAL (10-3) CONFIDENCE CONFIDENCE 0.08333-0.37987 0.161626-0.5004 0.0150-0.1176

1.2. INTRODUCTION Schistosomiasis is a disease caused by an infection acquired when humans come into contact with freshwater bodies infested with infected snails. It usually results in diarrhoea and blood in the stool; enlargement of the liver and the spleen and portal hypertension are common in advanced cases. Schistosome eggs embolise to the uterus, cervix and lower genital tract of girls and women to form fibrotic nodules known as “sandy patches” that result in a condition known as female genital schistosomiasis (FGS), which is associated with bleeding and pain, as well as social stigma and . In 2019, 45 of ESPEN mandate countries were endemic for schistosomiasis, and three of them (Botswana, Schistosomiasis and Equatorial Guinea and South Africa) had not started treatment by the end of 2019. ESPEN has been working with these countries to support processes that will lead to implementing urgent SCH control. Botswana has made significant progress in procuring adequate PZQ that will be distributed at the community level, while planning is going on in Equatorial Guinea with ESPEN-supported country missions. South Africa is working on an investment case for including domestic funding for MDA in the government budget. The aim is to ensure that all countries implement schistosomiasis control by the second quarter of soil-transmitted 2020 if the current COVID-19 crisis allows. STH infections are intestinal infections that are transmitted by contamination of soil with human excreta. The infections are caused by Ascaris lumbricoides (roundworms), Trichuris trichiura (whipworms), Necator americanus and Ancylostoma duodenale (hookworms) [21, 22]. In 2019, 44 of ESPEN-supported countries were requiring preventive chemotherapy for STH in at least one implementation unit. Of the countries helminthiasis requiring MDA, all except Equatorial Guinea started MDA. Despite a successful MDA campaign between 8 29 2012 and 2017, Zimbabwe did not implement MDA for the last two years (2018 and 2019). 1.1. SUMMARY 28 1.3. SCALE-UP OF INTERVENTIONS ESPEN’s major achievements in SCH and STH control in 2019 include: Mapping EESPEN contributed to the completion of STH/SCH mapping across Africa by the end of 2019. In 2019, • ESPEN supported the scale-up of MDA for STH in 15 countries (Cameroon, Cape Verde, Congo, ESPEN supported mapping in 151 health districts in three countries (Angola, South Africa and South Democratic Republic of the Congo, eSwatini, Equatorial Guinea, Gabon, Gambia, Kenya, Lesotho, Sudan). Angola finalised the mapping of SCH/STH in 125 municipalities. Namibia, Nigeria, Senegal, São Tomé and Príncipe, and Zambia) in 488 IUs targeting 21,390,340 people. In the same year, ESPEN supported South Africa to complete SCH/STH mapping in the three provinces of • ESPEN supported the scale-up of SCH MDA in 14 countries (Cameroon, Democratic Republic of the Free State, Western Cape and Northern Cape in 14 districts. In South Sudan, ESPEN supported SCH/STH Congo, Egypt, Eritrea, Gambia, Kenya, Mauritania, Namibia, Nigeria, Senegal, South Sudan, São Tomé mapping in 12 counties. All the countries, with the exception of South Africa, successfully utilised ESPEN and Príncipe, and Zambia) in 354 IUs targeting 24,231,435 people. Collect, allowing for real-time support in data management by ESPEN data staff. In Angola and South • Of the ESPEN mandate countries, at least 12 achieved 100% geographical coverage for STH MDA in 2019 Sudan, the finalisation of SCH/STH mapping was integrated with Guinea worm disease tracing. and 13 for SCH. Mass drug administration • ESPEN supported 22 countries to conduct subnational analysis of schistosomiasis mapping data to optimise MDA. The analysis showed that 1.4 million school-age children are missing treatment and 5.5 In 2019, ESPEN supported the scale-up of MDA for STH in 15 countries (Cameroon, Cape Verde, Congo, million tablets of praziquantel were distributed in areas where they are not needed. Democratic Republic of the Congo, eSwatini, Equatorial Guinea, Gabon, Gambia, Kenya Lesotho, Namibia, Nigeria, Senegal, São Tomé and Príncipe, and Zambia) in 488 IUs targeting 21,390,340 people. • ESPEN led the completion of baseline endemicity mapping for STH/SCH throughout Africa by supporting mapping in the last three remaining countries (Angola, South Africa and South Sudan) in 151 health districts, bringing the AFRO Mapping Project for STH and SCH to a successful completion. • All data is now publicly available at the ESPEN Portal (http://espen.afro.who.int). 1. Cameroon, Cape Verde, Congo, Democratic Republic of Congo, eSwatini, Gabon, Gambia, Kenya, Lesotho, Namibia, Senegal and São Tomé and Príncipe. 2. Cameroon, Democratic Republic of Congo, Egypt, Equatorial Guinea, Eritrea, Gambia, Kenya, Mauritania, Namibia, Nigeria, Senegal, South Sudan and São Tomé and Príncipe. BOX 5 BOX 4 five achieved treatment coverage above 75%. 78%, whichisjustabove theWHOrecommended minimumthreshold of75%.However, oftheeightIUs, the 187,490 targeted school-agechildren, 147,138 were treated, withanoverall treatment coverage of ofHealthinSouthSudanconducted thefirst for thefirsttime.MDA TheMinistry ineightcounties.Of schistosomiasis implemented.In2019,ESPEN supportedtheimplementationofMDA forschistosomiasis South Sudan,oneofthecountriesendemicforschistosomiasis,hadnodocumentedMDA against SOUTH SUDAN SCHISTOSOMIASIS LAUNCHED CONTROLPROGRAMME national programme officers, monitoringand evaluation officers, and/or datamanagers. A totalof107individualsparticipated inthedatatraining. For theparticipantsincluded eachcountry, Ethiopia andNigeria. level level validation atthecountry iscontinuing,while additionalsupportatthecountry willbeneededfor the rest ofthecountriestobetargeted in2020.Dataanalysis iscompleted for these22countriesand so farare thosewithsignificantpopulations requiring treatment ofmore than2.5million people, with implementation ofMDA toasubdistrict level Countries andotherinterventions. prioritisedforthesupport Senegal, SouthSudan, Tanzania, Uganda, ZambiaandZimbabwe) inanalysing thedataformore focalised Republic, Chad,DRC, Ethiopia, Gabon, Ghana, Kenya, Madagascar,Malawi, Mali,Niger,Namibia, Nigeria, from theESPEN Portalandsupported22countries(BurkinaFaso, Côte d’Ivoire, Cameroon, Central African ESPEN supportedtheconsolidation of prevalence datainendemiccountriestosupplementavailable require treatment, withtheaimofoptimisingusepraziquantel usingavailable data. epidemiological areas atthelowest possible administrative levels (subdistrict) requiring treatment andthosethatdonot ESPEN initiatedaconsultative process tosupportcountriesconduct subdistrict dataanalysis toidentify areas withhighprevalence where themeanprevalence islow. noncompliance (i.e., communitiesrefuse totake donatedmedicines),andpersistenceofmorbidityinfocal including wasted medicinesandresources, treatment fatigueinpopulationswithnoperceived needand by areas withnotransmission, thatmakes themeanprevalence drop. Thiscancauseseveral issues, undertreatment ornotreatment inareas thatneeditmost.Whenhighlyendemicareas are surrounded take intoaccountthefocalnature ofitsdistribution, canleadtoovertreatment insomeareas, orworse, individualsinendemicdistrictsto treat orimplementationunits.Thisstrategy, alleligible which does not distorted, asvariations atlower levels are masked. Thecurrent MDA strategy formany countrieshasbeen has itslimitations,becausewhenever anaverage isusedtorepresent thedistrict, theresults become the entire district tobeclassified asendemic(high, moderate or low) ornonendemic. Usingthemean ofthedistrict forMDAper school.Theeligibility isthendetermined by themeanprevalence thatallows by collecting stooland/or urinesamplesinasub-sampleofschoolsperdistrict, andsamplingchildren praziquantel availability foradultsatrisk.For schistosomiasis,thebaselineendemicitymappingwas done generous supportof250milliontablets ofpraziquantel by MSD annuallyforSAC, alarge gapstillexistsfor Schistosomiasis isoftenafocaldisease, andthemedicineusedforMDA isascarce resource. Despitethe DATA ANALYSIS FOROPTIMISATION OFMDA AGAINST SCHISTOSOMIASIS 2019. ZambiadidnotimplementMDA issues. duetologistical 24,231,435 people. Except forZambia , alltheothercountriesimplementedMDA forbothSCH andSTH in Namibia, NigeriaSenegalSouthSudanSãoTomé andPríncipe,Zambia)in354IUstargeting Democratic RepublicoftheCongo, Egypt, EquatorialGuineaEritrea, GambiaKenya, Mauritania 30 31

the country levelthe country andare now atthesubdistrict level. planningtheirnextinterventions int). Sofar,fourcountries(Malawi, Mali,SouthSudanandUganda)have completed theirdatavalidation at unknown endemicity. Thesetoolsare available fordownload ontheESPEN Portal(http://espen.afro.who. levels, whilethelocalknowledge ondiseaseepidemiology toolcomplementsdataknowledge gapsin analysis tool supportstheanalysis ofavailable subdistrict datafordecisionsattheselower administrative To supportcountries,ESPEN hasdeveloped two datasupporttoolsforthisanalysis. Thesubdistrict data where they are notneeded. unnecessarily. Thistranslates to5.5milliontablets ofpraziquantel beingdistributed annuallyinareas while 1.4millionchildren inendemicareas are missing treatment, and2.2millionchildren are beingtreated age children inanendemicdistrict shows thatupto7.6 millionschool-agechildren are adequatelytreated, datainthe22countries,currentBased ontheanalysis strategy andpreliminary oftreating allschool- is <2%,noPZQMDA was intervention recommended. treatment everytwo years forthenextfouryears was recommended. In66districts where theprevalence in eightdistricts where theprevalence is≥ 2%and<10%,administeringaround ofPZQanthelminthic inthecountry’sinterventions SCH/STH program plan. Basedontheresults of the impact assessment Nevertheless, hotspotspersistfrom various site-level data, callingformore focalizedtargeting ofadjusted districts withSTH prevalence >20%andnoneattheend-linesurvey. For STH prevalence, levels dropped from 6%to1%forSTH onaverage, butatbaseline there were five of MDA, eliminationofS. mansoniasapublichealthproblem was achieved inallZimbabwean districts. had prevalence infection intensities>1%forS. ofheavy mansoniinthebaselinesurvey, aftersixrounds infectionof S. intensity(≥50e/ml) haematobiumheavy >1%reduced from Whileeightdistricts 48 to12. The prevalence ofschistosomiasisreduced from 23.0% to5.0%. Thenumberofdistricts withprevalence The results showed asignificant reduction in STH diseaseprevalence atthedistrict andnationallevels. 13,950 children. had participatedinthebaselinesurvey, aswell asanadditional56sentinelschools.Thesurvey involved districts in10endemicprovinces were targeted forthesurvey, which was conducted in279schoolsthat data together withalladjacentsectors andplanforamultisector adjustedplanmoving All74 forward. a stakeholders’ consultative workshop inSeptember2019Victoria Falls toreview theimpact assessment The surveyhasbeencompleted anddataanalysis isgoingon. WithESPEN’s support,Zimbabwe alsoheld Zimbabwe conducted anSCH/STH impact assessment surveynationwide. an impact assessment surveytodecideifanadjustedstrategy forMDA was needed.WithESPEN support, Zimbabwe hadconducted ahighcoverage MDA consistentlyforsixyears, andtheRPRGhadrecommended DRUG ADMINISTRATION 1.4. SCALE DOWN: REDUCING INFECTIONANDDISCONTINUING MASS Impact assessment results of soil-transmitted Helminthiasis (STH) in Zimbabwe by province. Zimbabwe implemented MDA for STH for six consecutive years (2012-2017). Based on the RPRG 1.5. TECHNICAL SUPPORT AND LEADERSHIP recommendations, the country conducted an impact survey in 2018-2019. The figure below shows the ESPEN provided a variety of technical support for endemic countries. In collaboration with the Institutional results of the impact assessment (2018) compared to the baseline (2010). Network on China-Africa Collaboration on Schistosomiasis (INCAS), ESPEN provided training on snail vector distribution assessments and control. The training is the fourth session since the start of the partnership OVERALL FIG. 6 and included updates on participating country progress on INCAS collaboration, updates on infected snail MASHONALAND EAST Prevalence (%) control and a deep dive into the Ethiopian intermediate snail ecology. MASHONALAND NORTH Baseline To support STH/SCH activities in the region, ESPEN identified and provided training for 24 experts across MASVINGO Post MDA the region alongside 24 WHO National Professional Officers (NPOs) from 24 prioritized countries based on MANICALAND population requiring SCH MDA. This training was aimed at keeping experts from endemic countries and CHITUNGWIZA partners aligned and updated on the WHO agenda and control and elimination activities in countries, and MIDLANDS ensuring countries get the technical support they need. Experts were provided with a range of WHO and

MASHONALAND WEST partner tools available for supporting NTD programmes. HARARE ESPEN is developing the SCH/STH roster of experts in order to have a critical mass of experts who are MASHONALAND CENTRAL aligned with the collective NTD control and elimination agenda and available to support NTD programmes, BULAWAYO primarily in their countries of origin but also at the regional level. Furthermore, ESPEN contributed to

MATEBELELAND SOUTH international forums by presenting the progress in the region. ESPEN supported countries technically on developing their SCH/STH elimination strategies, advocacy tools, high-level advocacy and impact 20 15 10 5 0 5 assessment. ESPEN also supported countries on the management of severe adverse events following MDA. POST MDA (2018) BASELINE (2010) PREVALENCE (%) Two other countries, eSwatini and Eritrea, received technical and financial support from ESPEN to develop impact assessment protocols, sentinel site monitoring protocols, and sentinel sites for monitoring of Impact assessment results of schistosomiasis in Zimbabwe stratification of districts into SCH/STH impact. The WHO recommends a drug efficacy survey as part of monitoring for largescale MDA 33 schistosomiasis risk categories according to WHO guidelines. programmes. As part of the ESPEN-supported SCH/STH impact assessment in Zimbabwe, a layered drug The figure below shows the results of the impact assessment (2018) compared to the baseline (2010). efficacy survey was included.

Impact assessment results of schistosomiasis in Zimbabwe by province. 32 FIG. 8 Number of Districts Zimbabwe implemented MDA for SCH for six consecutive years (2012-2017). Based on the RPRG Baseline recommendations, the country conducted an impact survey in 2018-2019. The figure below shows the Post MDA results of the impact assessment (2018) compared to the baseline (2010). NUMBER OF DISTRICTS

GLOBAL No risk (0%) 7 23 MASHONALAND CENTRAL FIG. 7 MASVINGO Prevalence (%) Low (>0% to <10%) 19 23 MASHONALAND EAST Baseline MIDLANDS Post MDA Moderate (≥10% to ≤50%) 40 8 MANICALAND

MASHONALAND WEST High (≥50%) 5 0 HARARE

MATEBELELAND SOUTH

CHITUNGWIZA 50 40 30 20 10 0 10 20 30 40 50

MATEBELELAND NORTH BULAWAYO

20 15 10 5 0 5

POST MDA (2018) BASELINE (2010) PREVALENCE (%) 1.2. INTRODUCTION Trachoma is the leading infectious cause of blindness in the world. The infection spreads from person to person through contaminated fingers, fomites and flies that came into contact with discharge from the eyes and nose of an infected person [23, 24]. Repeated infections in early childhood lead to scarring of the inner side of the upper eyelids, resulting in the inward turning of the eyelid margin with the lashes touching the globe, a condition known as trachomatous trichiasis (TT). TT is a very painful condition, as eyelashes rub the cornea with each blinking action, resulting in corneal opacity and eventually in an irreversible visual impairment and blindness. Trachoma is controlled by using the WHO-recommended “SAFE strategy.” SAFE stands for surgery for TT, antibiotics to clear the bacterial infection, facial cleanliness, and environmental improvement (especially improved access to water and sanitation) to reduce transmission. Trachoma is widespread in Africa. Of the 44 endemic countries for trachoma worldwide, 28 (64%) are found on the continent. Of the 52 ESPEN mandate countries, 29 are endemic for trachoma and are known to require interventions, whereas 16 countries are believed to be non-endemic. Four countries (Angola, Botswana, Namibia and Somalia) may require intervention, so investigations are needed. The Gambia and Togo claim to have eliminated trachoma. Ghana is the only country in the region to have been validated as Trachoma having eliminated trachoma as a public health problem. 1.3. SCALING UP OF INTERVENTIONS 1.1. SUMMARY Preliminary investigations 35 Establishment of the endemicity status in three countries (Angola, Botswana and Namibia) is needed to 9 ESPEN’s major achievements in complete the mapping gap for trachoma in the WHO African Region. The status of trachoma endemicity in trachoma control in 2019 include: these three countries is currently labelled as “may require interventions, investigations needed.” In 2019, ESPEN conducted the required investigations in collaboration with the respective WHO country offices • ESPEN supported trachoma MDA in the 34 and national ministries of health to decide on the next steps. Based on the preliminary investigations, the Democratic Republic of the Congo, Ethiopia following recommendations were made: and Sudan in 68 IUs targeting 10,236,410 • In Angola, formal population-based trachoma prevalence surveys should be conducted in Cunene, individuals. Namibe and Benguela provinces in the first survey phase to establish the prevalence of active • ESPEN conducted preliminary investigations infection (trachomatous inflammation – follicular (TF)) in children 1–9 years old and the prevalence in collaboration with respective WHO country of TT in those 15 years old and up in each evaluation unit. The reported high prevalence of active offices and national ministries of health to trachoma from a previous rapid assessment in the province of Uige could not be confirmed, therefore, establish endemicity of trachoma in 2020. conducting a trachoma prevalence survey there is not warranted. • ESPEN developed a pre-approved roster • In Botswana, a population-based trachoma prevalence survey is recommended in Ngamiland district of 18 trachoma experts to serve as ad-hoc to establish the prevalence of TF in 1- to 9-year-olds and of TT in those 15 years old and up, and members of a trachoma elimination dossier provide the evidence for inclusion in the trachoma elimination dossier should TT not be a public review group. health problem in the district. • ESPEN provided support for the development • In Namibia, formal population-based trachoma prevalence surveys should be undertaken in the of a trachoma elimination dossier for Zambezi and Kunene regions in the first survey phase in order to establish whether the observed Mauritania and technical support for the existence of active trachoma and TT in the country is of public health significance or not. revision of the Togo dossier. ESPEN will support the implementation of mapping in these three countries in the second quarter of 2020 • ESPEN provided support for trachoma in collaboration with partners. impact surveys in 18 health districts in the Democratic Republic of the Congo. Mapping The Central African Republic is among the known endemic countries with a mapping gap for trachoma and a need for ESPEN support. In 2019, ESPEN provided that support for the mapping of five EUs in Ouham and Ouham-Pendé. The mapping was initially planned for 2019 but had to be postponed to February 2020 due to challenges within the country. CAR would require doing surveys in four additional EUs to complete trachoma mapping in the country. At the end of 2019, there was a mapping gap of 57 IUs in five countries Central( African Republic, Chad, Democratic Republic of the Congo, Nigeria and South Sudan).. Scale-up of mass drug administration In 2019, ESPEN supported trachoma MDA in the Democratic Republic of the Congo, Ethiopia and Sudan in 68 IUs targeting 10,236,410 individuals. In the DRC, MDA was conducted in 15 health districts targeting 2,989,356 people. In Ethiopia, ESPEN supported one round of MDA in 48 districts (19 in Afar, two in Oromia and 27 in Somali) with a TF prevalence of 5% to 9.9% targeting 3,386,298 people. This support would enable Ethiopia, the country with the highest trachoma burden in the world, to reach 100% geographic coverage for trachoma MDA for the first time in its trachoma control history. InSudan , ESPEN supported MDA in five IUs in North Darfur and West Darfur, targeting 3,860,756 people to cover gaps in funding for trachoma MDA. 1.4. SCALE DOWN Elimination dossier 37 Trachoma Dossier Review Group (DRG) Roster As the countries progress in the implementation of the intervention, it is expected that the number of countries submitting national elimination dossiers will increase. In preparation 36 for this, ESPEN has developed a pre-approved roster of 18 trachoma experts to serve as an ad-hoc members of a trachoma elimination dossier review group to be constituted as per the established DRG guidelines. Support in dossier preparation ESPEN provided funding to Mauritania to help recruit a consultant to support the development of a trachoma elimination dossier for the country. The draft dossier is expected to be finalized in 2020 during a workshop. In addition, ESPEN provided technical support to Togo to help address the issues raised by the DRG in its first review of the country’s trachoma elimination dossier. Impact surveys In 2019, ESPEN provided funding to support trachoma impact surveys in 18 health districts in the Democratic Republic of the Congo. 1.5. TECHNICAL SUPPORT AND LEADERSHIP In 2019, ESPEN played an important role at the regional and global levels. ESPEN attended and contributed to regional and global fora such as the Carter Center Annual Trachoma Review Meeting, TEC and GET2020 meetings, and the Southern African Cross Border Meeting on NTDs and Trachoma. ESPEN also provided remote and in-person technical support for countries. NATIONAL AND ESPEN-SUPPORTED IUS TREATMENT COVERAGE IN ESPEN-SUPPORTED COUNTRIES IN 2018

Table 3 Table ALL IMPLEMENTATION UNITS IMPLEMENTATION UNITS SUPPORTED BY ESPEN

Disease Number Number of Geographic Population Number of National Number of IUs treated Population Number of persons treated Coverage COUNTRY of IUs IUs treated coverage requiring preventive persons coverage COUNTRY requiring preventive requiring PC chemotherapy treated chemotherapy ONC 11 11 100 1,825,304 1,514,812 83 11 1,825,304 1,514,812 83 Burundi Burundi STH 46 46 100 4,412,299 4,177,021 94.7 11 1,179,490 1,137,552 96.4 STH 189 189 100 9,879,213 3,312,396 33.5 189 9,879,213 3,312,396 33.5 Cameroon Cameroon SCH 120 22 18.3 4,252,095 538,768 12.7 22 1,006,363 538,768 53.5 LF 22 22 100 4,175,279 3,404,103 81.5 16 3,316,030 2,749,014 82.9 Chad Chad ONC 30 30 100 4,841,981 4,036,342 83.4 16 3,316,030 2,749,014 82.9 LF 12 6 50 962,668 250,570 26 6 551,879 250,570 45.4 Congo Congo ONC 17 17 100 678,758 548,687 80.8 16 630,416 508,536 80.7 LF 245 234 95.5 48,034,533 36,811,289 76.6 34 5,564,798 4,514,445 81.1 ONC 268 267 99.6 50,388,598 39,752,882 78.9 27 4,141,285 3,334,623 80.5 DRC DRC STH 304 267 87.8 28,066,104 14,518,423 51.7 16 1,160,835 732,673 63.1 SCH 280 144 51.4 15,793,248 4,479,728 28.4 14 634132 341,028 53.8 LF 2 2 100 71,584 62,496 87.3 2 71,584 62,496 87.3 Eritrea Eritrea SCH 27 8 29.6 269,069 93,818 34.9 8 97600 93,818 96.1 SCH 55 50 90.9 271,193 269,107 99.2 50 271,193 269,107 99.2 eSwatini eSwatini STH 3 31 1033.3 16,659 139,168 835.4 39 31 16,659 139,168 835.4 Ethiopia TRA 668 478 71.6 77,653,062 62,658,840 80.7 Ethiopia 42 3,383,196 3,008,856 88.9 STH 47 47 100 483,207 128,533 26.6 47 483,207 128,533 26.6 Gabon Gabon SCH 44 44 100 192,879 141,007 73.1 38 44 192,879 141,007 73.1 SCH 23 22 95.7 123,116 59,394 48.2 22 123,116 59,394 48.2 Gambia Gambia STH 4 1 25 70,776 34,139 48.2 1 54961 34,139 62.1 SCH 216 49 22.7 10,588,270 1,012,948 9.6 49 5023767 1,012,948 20.2 Ghana Ghana STH 216 63 29.2 10,875,475 1,245,103 11.4 63 2573208 1,245,103 48.4 Lesotho STH 7 7 100 382,336 197,652 51.7 Lesotho 7 382,336 197,652 51.7 Malawi ONC 8 8 100 2,480,265 2,054,160 82.8 Malawi 8 2,480,265 2,054,160 82.8 Nigeria SCH 583 253 43.4 25,070,925 6,967,968 27.8 Nigeria 31 1,673,604 834,155 49.8 STH 23 23 100 3,715,035 3,666,384 98.7 13 2,051,601 2,026,787 98.8 Rwanda Rwanda SCH 22 22 100 1,179,683 932,153 79 13 635,386 546,341 86.0 LF 29 6 20.7 5,904,795 1,019,621 17.3 4 945289 835,793 88.4 South Sudan ONC 46 19 41.3 7,467,149 1,665,161 22.3 South Sudan 8 1121775 1,012,279 90.2 STH 6 3 50 669,157 190,925 28.5 3 414745 190,925 46.0 LF 7 7 100 201,784 162,512 80.5 7 201,784 162,512 80.5 São Tomé and Príncipe STH 7 7 100 77,687 68,874 88.7 São Tomé and Príncipe 7 77,687 68,874 88.7 SCH 7 2 28.6 38,155 16,835 44.1 2 31,819 16,835 52.9 Sudan TRA 18 8 44.4 4,150,403 2,122,507 51.1 Sudan 4 1,445,696 1,567,586 108.4 Yemen ONC 33 33 100 628,728 550,131 87.5 Yemen 33 628,728 550,131 87.5

LF= Lymphatic Filariasis ONC= Onchocerciasis STH= Soil-Transmitted Helminthiasis SCH= Schistosomiasis TRA=Trachoma DRC= Democratic Republic of the Congo POPULATION AND IUS TARGETED FOR MDA SUPPORT WITH ESPEN FUNDING IN 2019 Table 4 Table POPULATION AND IUS TARGETED FOR MDA BUDGET LF ONCHO SCH STH TRACHOMA COUNTRY COUNTRY Total #IUs Total USD Targe #IUs Target #IUs Target #IUs Target #IUs Target #IUs

Burundi 1,606,922 12 Burundi 12 1,606,922 100,000 Cameroon 4,239,553 113 6,812,916 189 Cameroon 189 6,812,916 285,000 Cape Verde 70,845 22 Cape Verde 22 70,845 11,000 Comoros 788,813 17.00 Comoros 17 788,813 2018 Budget¥ Congo 540,634 6 653,241 17 725,950 25 Congo 29 1,674,995 472,250 DRC 6,383,459 46 4,151,033 29 1,731,031 28 2,098,873 34 2,989,356 15 DRC 46 6,383,459 1,600,000 Egypt - - - - 5,066,393 20 - - - - Egypt 20 5,066,393 400,000 Eq. Guinea* 909,888 15 131,556 13 371,991 18 Eq. Guinea* 18 909,888 81,720 Eritrea 69,634 2 NA 263,215 27 - - Eritrea 29 437,708 269,176.5 eSwatini 106,092 22 eSwatini 22 106,092 10,000 Ethiopia ------3,386,298 48 Ethiopia 48 3,386,298 850,329 Gabon 373,109 47 41 Gabon 47 373,109 225,577 Gambia 79,346 4 79,346 4 Gambia 4 79,346 17,997 Kenya 1,240,628 11 2,499,764 16 Kenya 16 2,499,764 300,000 Lesotho 449,287 11 40 Lesotho 11 449,287 175,352 Madagascar 3,883,148 18 Madagascar 18 3,883,148 2018 Budget¥ Malawi 2,480,265 8 Malawi 8 2,480,265 132,416 Mauritania 176,439 11 Mauritania 11 176,439 110,137 Namibia 268,214 12 406,264 22 Namibia 22 406,264 2018 Budget¥ Nigeria 5,227,136 25 4,987,478 40 2,714,245 9 Nigeria 74 12,928,859 361,758 Senegal 2,871,686 22 2,871,686 22 Senegal 22 2,871,686 17,911 South Sudan - - - - 1,434,099 8 - - South Sudan 8 1,434,099 813,464 STP 206,423 7 6,254 5 74,429 7 STP 7 206,423 132,374 Sudan ------3,860,756 5 Sudan 5 3,860,756 472,822 Yemen - - 628,710 33 ------Yemen 33 628,710 406,605 Zambia* 1,735,543 40 1,735,543 40 Zambia* 40 1,735,543 246,876 TOTAL 18,009,135 136 9,520,171 99 24,231,435 354 21,390,340 488 10,236,410 68 TOTAL 778 61,258,027 7,223,587

* Treatment round postponed to 2020, ¥ The MDA in these countries was planned in 2019 using budget transferred from 2018. skilled personnel and platforms. To support countries, ESPEN developed two platforms, ESPEN Portal and ESPEN Collect. ESPEN Portal is an online platform where data on historical and contemporary disease distribution, Strengthening information disease-specific epidemiological surveys, treatment coverage, and other data are stored and openly shared with users. The portal also has a function for developing interactive maps that users can use to visualise online or print. ESPEN Collect is a mobile application platform to collect, store and visualise real-time data. The tool management systems enables the collection of standardized data across disease-specific surveys and improves the quality and timeliness of the data.

1.1. SUMMARY ESPEN SUPPORTED COUNTRIES ON DATA MANAGEMENT

ESPEN’s major achievements in information management system strengthening in 2019 6 BOX ESPEN has organised country support missions to develop integrated NTD databases by hiring include: consultants. In each country, ESPEN consultants, in collaboration with the NTD team, developed NTD data flow, a partner matrix, an integrated NTD database and an implementation unit-level microplanning • ESPEN conducted country data support missions in 17 countries (Angola, Botswana, Comoros, Republic on activities for three years. The following 17 countries were supported: Angola, Botswana, Comoros, of Congo, Côte d’Ivoire, eSwatini, Gabon, Gambia, Guinea-Bissau, Kenya, Malawi, Mali, Niger, Rwanda, São Republic of Congo, Côte d’Ivoire, eSwatini, Gabon, Gambia, Guinea-Bissau, Kenya, Malawi, Mali, Niger, Tomé and Príncipe, South Sudan and United Republic of Tanzania (mainland and Zanzibar) Rwanda, São Tomé and Príncipe, South Sudan, and United Republic of Tanzania (mainland and Zanzibar). • Using the outcomes of the country support missions, ESPEN developed a workbook to project preventive chemotherapy activities required in each implementation unit for the next five years. This tool is a resource being made available to country NTD programmes to support data-driven decision-making. In 2019, ESPEN supported 17 countries (Box 6). For each country two international ESPEN consultants from • The ESPEN Portal now has 3,508 maps, as well as underlying datasets for all PC-NTDs. the prequalified roster were hired and stayed over a two-week period. The purpose of the mission was to capture NTD data flow, fill the partner matrix, set up a country-integrated NTD database (CIND), create • In 2019, 9,255 users from 153 countries (including 51 countries in Africa) visited the ESPEN Portal during 43 a sub-implementation unit demography database, and develop a three-year implementation unit-level 19,362 sessions. 10 preventive chemotherapy plan that includes trends in endemicity status, demographic data, and planned • 1,615 surveys from eight countries (Angola, Burkina Faso, Central African Republic, Equatorial Guinea, activities. Remote support is being provided to the 17 countries after the missions. The ESPEN consultants, Mozambique, Nigeria, Sierra Leone and South Sudan) used the ESPEN Collect platform. along with the respective country NTD teams and local implementing partners, reviewed historical and 42 contemporary site-level data and revised the endemicity status of implementation units. The team also developed data flow analyses, which will help countries identify the path for the data reporting and act on 1.2. INTRODUCTION areas needing intervention. The mission identified historical data that were not captured through the ESPEN Data-driven decision-making is one of the key pillars of ESPEN. If NTD programmes are to be successful, the Portal. For each country, a CIND and a partner matrix were developed, which will be fed into the ESPEN collection and use of programme and epidemiological data are critical. The amount of data collected through portal. With the support of the consultants, countries were able to develop a three-year roadmap, which the NTD programme is enormous, and properly collecting, storing, analysing and using these data might require outlines what preventive chemotherapy activities will be conducted in each implementation unit over the coming three-year period, including MDA, impact assessment such as sentinel site surveys, pre-TAS and TAS, FIG. 9 post-elimination surveillance, TT-only surveys, TIS, pre-validation surveys, entomological surveys, and other activities. In addition, after developing the database, training was provided for five days to a total of 450 data Number of trainees managers and NTD staff across the 17 countries (see Figure 6).

CIND TIPAC EXCEL STATA GIS NIGER NIGER NIGER TANZANIA ZANZIBARTANZANIATANZANIA ZANZIBAR ZANZIBAR TANZANIA (MAINLAND)TANZANIATANZANIA (MAINLAND) (MAINLAND) CONGO CONGO CONGO BOTSWANABOTSWANABOTSWANA RWANDA RWANDARWANDA THE GAMBIATHE GAMBIATHE GAMBIA MALI MALI MALI ESWATINI ESWATINIESWATINI GABON GABON GABON KENYA KENYA KENYA SÃO TOMÉ ANDSÃO PRÍNCIPETOMÉSÃO AND TOMÉ PRÍNCIPE AND PRÍNCIPE MALAWI MALAWIMALAWI GUINEA-BISSAUGUINEA-BISSAUGUINEA-BISSAU ANGOLA ANGOLAANGOLA CÔTE D’IVOIRECÔTE D’IVOIRECÔTE D’IVOIRE COMORES COMORESCOMORES 0 10 0 20 100 30 2010 40 3020 50 4030 60 5040 6050 0 60 5 100 155 0 1020 5 152510 203015 253520 304025 3530 4035 0 40 10 0 20 100 30 2010 40 3020 50 4030 60 5040 6050 0 60 10 0 20 100 30 2010 40 3020 50 4030 60 5040 6050 0 60 2 0 4 20 6 42 8 64 10 86 12 108 1210 12 1.3. ESPEN PORTAL

The ESPEN Portal was launched in 1.5. IMPLEMENTATION UNIT-LEVEL PREVENTIVE CHEMOTHERAPY FIG. 10 USERS 2018 and now has 3,508 maps, as 3 687 FORECAST well as underlying datasets for all Audience of the 9 255 PC-NTDs. Using the outcomes of the country support missions, ESPEN has developed a workbook to project the preventive ESPEN Portal, chemotherapy activities required in each implementation unit for the next five years. This tool provides country Data is available at both the and regional dashboards highlighting the number of impact assessment surveys, MDA gaps (geographic and implementation unit level for endemicity NEWS USERS epidemiological) and the estimated cost of MDA. This tool is a resource being made available to country NTD status and treatment coverage, and at the 2018 and 2019 3 317 SESSIONS 8 436 programmes to support data-driven decision-making. site-level for survey results. 8 999 19 362 In 2019, FIG. 11 9,255 users Compared to 2018, this represents a 150% increase in terms visited the portal from of users and a 115% increase in terms of sessions (see graph Sample workbook 153 countries below). The portal also includes resources such as country NTD master plans, a partner matrix, RPRG reports, ESPEN (including 51 countries in Africa) during annual reports and disease elimination dossiers. 19,362 sessions.

In April 2019, the WHO launched global consultations for the new NTD Roadmap 2021-2030. As part of this effort, ESPEN convened a meeting of partner institutions involved in NTD monitoring and evaluation June 3-7, 2019. A total of 11 participants from CNTD/LSTM, Sightsavers, Geneva Global, USAID’s Act to End NTDs/East and West, USAID, SCI, the END Fund, KIT and LSHTM reviewed available country data and identified main indicators to be used for developing country summary snapshots. A list of 59 country-level and 39 regional-level indicators were identified. Based on the outcomes of this meeting, ESPEN developed a draft IU-level forecast of PC activities and country summaries. This was shared 45 during the NTD programme managers’ meeting in July 2019 in Addis Ababa, Ethiopia. This list of indicators will be used to track regional progress on the NTD Roadmap 2021-2030 and will be available through the ESPEN Portal. 1.4. ESPEN COLLECT 44 In 2019, a total of 1,668 sites from eight countries used ESPEN platform to conduct disease-specific assessments and baseline mappings. The different surveys conducted using ESPEN Collect were onchocerciasis elimination mapping (30%), baseline mapping (30%), LF pre-TAS (10%), coverage monitoring (10%), breeding site assessment (10%) and ONCHO impact assessment (10%). More than 237 people were trained on how to use ESPEN Collect for data collection in eight countries: Angola, Burkina Faso, Liberia, Mozambique, Nigeria, Republic of Congo, Sierra Leone and South Sudan. In addition to disease-specific assessment, ESPEN conducted a pilot project to use ESPEN Collect for routine reporting of treatment data. The pilot has been run in the Republic of Congo in 14 health facilities. 1.6. STRONG PARTNERSHIPS FOR STRONG DATA SYSTEMS ESPEN has a well-established and strong partnership with the London School of Hygiene and Tropical Medicine (LSHTM), COUNTRY ONCHO LF SCH STH SURVEY TYPE Number of sites Manta Ray Media, Sightsavers and Standard Code to strengthen data systems in Africa. Angola 567 567 Baseline mapping surveyed using ESPEN Burkina Faso 14 LF pre-TAS Collect SYSTEM The LSHTM provides continued technical support in data management and developing country profiles, including maps. Burkina Faso 60 16 Coverage monitoring survey Table 5 Table It also provides capacity building training and data analysis support. Central African Republic 9 22 22 Baseline mapping Equatorial Guinea 70 Onchocerciasis elimination mapping Manta Ray Media provided services to develop visualisation methods. Standard Code hosts ESPEN data and developed Mozambique 54 Onchocerciasis elimination mapping the automation of the ESPEN Portal and ESPEN Collect. Sightsavers provided two technical staff who are fully dedicated Mozambique 37 Breeding sites assessment to the implementation of ESPEN Collect and participates in the overall data strategy by providing additional data experts Nigeria 14 Onchocerciasis elimination mapping from their staff. Sierra Leone 143 Onchocerciasis impact assessment South Sudan 37 48 48 Baseline mapping A JAP automation tool is under development to improve the quality, transparency and timeliness of submission and TOTAL 318 67 615 615 review. Improving the effective use 1.3. SUPPLY CHAIN SUPPORT MISSION ESPEN-SUPPORTED COUNTRIES ON SUPPLY CHAIN MANAGEMENT ESPEN staff and WHO HQ jointly organised country supply chain support missions in four countries

of donated medicines through 7 BOX (Cameroon, Mozambique, Niger and Rwanda). The missions supported the countries in recovering unused and unaccounted for medicines. enhanced supply chain 35,359,494 tablets were reported in stock for use in 2020. At least US management $2,864,016 were saved. In the last few years, one of the major supply chain challenges has been the inaccuracy of information on the inventory of donated medicines as compared to treatment reports. This resulted in significant amounts of unaccounted medicines. In response, ESPEN and WHO HQ conducted four country supply chain support 1.1. SUMMARY missions (Table 6). ESPEN’s major achievements in supply chain management in 2019 include: During the missions, the team conducted document reviews on country progress in service provision, including MDA, confronting the theoretical stock of donations from 2012 with treatment data, and conducting • ESPEN conducted supply chain support missions in four countries (Cameroon, Mozambique, Niger physical inventory verification of available balances of medicines. The missions provided tailored 11and Rwanda). recommendations and conducted advocacy for the countries to reconcile unaccounted medicines in each • The supply chain support missions recovered a total of 35,359,494 tablets with an estimated worth of country. In the four countries, the missions recovered a total of 35,359,494 tablets with an estimated worth of US $2,864,016. 47 US $2,864,016. • Through a JAP review, a total of 201,068,494 tablets were saved at an estimated worth of US $15,690,250. TABLETS RECOVERED FOLLOWING SUPPLY CHAIN MISSIONS • ESPEN provided technical support and guidance to enhance the timeliness and accuracy of 46 COUNTRY ALBENDAZOLE MEBENDAZOLE PRAZIQUANTEL Table 6 Table data through the JAP review process to improve the quality of medicine applications, reducing Cameroon 150,000 3,550,000 5,700,000 unnecessary quantities of medicines and re-allocating them where they were most needed. By the end of 2019, 45 JAPs were reviewed and 24 were cleared. Mozambique 6,000,000 2,873,553 Niger 7,055,141 10,180,800 Rwanda 1.2. INTRODUCTION Total tablets saved 13,055,141 3,550,000 18,754,353 Mass drug administration, a cornerstone of the NTD programme, is made possible through the generous 35,359,494 donation of medicines by pharmaceutical companies and donors. One of ESPEN’s primary objectives is to ensure the effective use of these donated medicines through enhanced supply chain management (SCM). 264,103 175,725 2,424,188 Cost (USD) ESPEN has established a robust application system for medicines. Each year, countries are required to 2,864,016 submit their progress interments of treatment, epidemiological data and requests for medicine. These data are jointly validated by ESPEN staff and WHO HQ by comparing the previous year’s request and progress reports as well as population figures. Through this rigorous exercise, countries are provided feedback to revise their request or provide explanations. 1.4. SUPPLY CHAIN TECHNICAL GUIDANCE Subsequently, countries submit a refined application, then the ESPEN team approves the applications. Each year, countries are required to report on the use of medicines, medicines in stock, MDA progress, ESPEN provides support to countries in applying for donated medicine by prepopulating the Joint and requests for medication for the next year through the JAP form. In 2019, 19 countries were advised Application Package with the information available at the ESPEN Portal. ESPEN also provides support to go back and review their medicines in stock, where they found 201,068,494 tablets. This resulted in a in justifying unaccounted medicines and building the capacity of the country team on supply chain and significant reduction in medicines ordered unnecessarily (Table 7). By the end of 2019, 24 countries were application procedures. supported in the JAP application, including help on the consistency of data and inventory guidance to properly account for current stock. This, along with the updated number of people requiring treatment, was used to recalculate the requested amounts of each medicine. Table 7 Late submission, poor quality, late JAP SUBMISSION, REVIEW JAP SUBMISSION,REVIEW review, approval and clearance. Limitation inproduction (capacity, coordinators andtheSupplyChainForum partners,followed by acascade training. chain managementforNTDs afteraninclusive review process withNTDsupplychainmanagers, drugslogistics SOPs toFrench andPortuguese, andthey willbedispatchedtocountries forwiderusetoensure strong supply of standard operating procedures (SOPs)ondifferent aspects ofthesupplychain. ESPEN translated these ESPEN isanactive memberoftheNTDsupply chainforum.Through theforum, ESPEN contributedtothereview 1.5. TECHNICAL SUPPORT ANDLEADERSHIP PURCHASE ORDER Supply chain-related challenges Fig. 12 NUMBER OFTABLETS ACCOUNTED FORTHROUGH COUNTRY JAP REVIEW TOTAL Diethylcarbamazine (LF) Praziquantel (SCH) Mebendazole (STH) Albendazole (STH) Albendazole (LF) MEDICINE timing, etc.) timingof MDA AND CLEARANCE Late purchase order raising PHARMACEUTICAL PRODUCTION TABLETS INITIALLY 624,072,020 212,098,609 261,109,020 39,423,479 52,207,735 REQUIRED 59,233,177 Late green light,taxexemption, poor information management. Poor inventory level, at country pre-shipment inspection ADMINISTRATION special labelling and GREEN LIGHT MASS DRUG TABLETS CLEARED 423,003,527 147,548,876 161,359,352 38,075,176 75,511,348 508,775

TABLETS SAVED Booking time. SHIPPING Lack of funds, transport, etc. IN-COUNTRY DISTRIBUTION 201,068,494 113,560,145 50,739,257 51,698,960 -16,278,171 1,348,303 warehouse of poor quality. Delayed clearance of Shortage COUNTRY WAREHOUSE CUSTOM & CLEARANCE AMOUNT (USD) $15,690,250 $14,678,784 -$805,769 $1,014,785 $775,484 $26,966

48 49 • • • ESPEN’s majorachievements inpartnershipsandresource mobilisationin2019include: RESOURCE MOBILISATION PARTNERSHIPS, COORDINATIONAND National Programme Managersmeeting. WHO-AFRO, RPRGmembers,programme managersfrom ministriesofhealth, NPOs,andpartners,fortheSecond country ESPEN NTDProgramme andtheRegional gathered almost300participants,includingrepresentatives from WHOHQand scorecardwhich ledtothecreation forNTDs. oftheAfrican LeadersMalariaAlliance(ALMA) ESPEN isplaying aleadingcoordinating mechanismrole, partnerstogether inAddis inFebruary includingbringing 2019, period offouryears. the Bill&MelindaGatesFoundation. Alleightprovided catalytic fundingintheamountofUS$31.5 millionforESPEN over a International Development,ofHealth, theJapanMinistry theQatarFund, Korea InternationalCooperation Agency, SDC and ESPEN mobilisedmajordonors,includingtheUSAgency forInternationalDevelopment, MSD, Germany, UKDepartmentfor against NTDs. Hemade specific reference to ESPEN andtheportal.H.E.Aïssata Issoufou Mahamadou,FirstLady ofNiger, former President ofGhana, published anop-edonWorld HealthDay andinvited African headsofstate tojoinhiminthefight There were othernotableinfluencerswhopubliclysupported ESPEN andthefightagainstNTDs in 2019. H.EJohnA.Kufuor, committing tothefightagainstNTDs. In 2019,there were 61 articles relating toESPEN. through ablogonNTDs, apublishedpieceby Dr.RebolloPoloofESPEN, andapublishedop-edwithsingerYoussou Ndour Traditional mediaactivity in2019includedapublishedop-edsigned by Dr.Moeti, promotion oftheAfrican Unionmeeting for good.Mediaactivity hasfocusedonraising awareness ofNTDs more andencouraging peopletoengageinthefight. In 2019,there were numerous mediaopportunitiestoamplify theissue ofNTDs andthepossibility ofeliminatingthem ESPEN inthenews to show progress andremain ontrack. Thiswork isnow beingconducted inGuinea. year. Itisimportantthatadvocacy efforts feedintoastronger nationalaccountability mechanismthatwillenablecountries todesignthecountry’sBecause ofthisaction, ofHealthcollaborated withALMA firstNTDscorecard theNigerMinistry this the tracking ofprogress andstrengthening accountabilityforcontrol andeliminationacross thecontinent. scorecard—a mechanismforaction andaccountabilitydeveloped primarilyforheadsofstateandgovernment tofacilitate level partnersinthefightagainstNTDs in2019.Thisincludedwhenthe African Unionannouncedin theALMA February to accelerate theeliminationoffive PC-NTDs inthe African region. ESPEN together high- was criticalinbringing governmentsis uniquelypositionedasacoordinating mechanism,bringing andtherest oftheNTDcommunitytogether as thetime-sensitive goalofNTDelimination, isalsocore indrivingthisaction. BuildingonWHO-AFRO’s mandate, ESPEN An enablingenvironment toensure political,socialandlegislative supportofNTDprevention, treatment andcare, aswell health coverage, itiscrucialtoeliminatethesediseases,whichgoeshandinwithESPEN’s mission andgoals. Strong partnershipsandcollaboration are akey success driver in action towards eliminationofNTDs. To achieve universal 1.2. PARTNERSHIPS ANDCOORDINATION 1.1. SUMMARY 12 Objective 1. Scale up MDA 9,796,296 US$ highlighted the crucial role of ESPEN in the fight against NTDs in Africa in an op-ed published in the print version Mapping 1,755,351 US$ of “Jeune Afrique” magazine during the African Union Summit in January 2019. In addition to articles in traditional financial MDA 6,891,561 US$ media, multiple videos were produced, including a video on the elimination of LF as a public health problem in Togo; MMDP capacity building 76,919 US$ a video about the elimination of trachoma in Ghana; and a video showcasing the hardship of a young girl, Mansoura ONCHO elimination mapping meeting 292,470 US$ Tidjani, affected by schistosomiasis. Such videos are meant to shed light on the progress made at the country level Subnational analysis of SCH mapping data to optimize MDA 461,223 US$ and encourage further investment and collective action in NTD interventions. overview Trachoma preliminary investigations 2,418 US$ In 2019, there was also a collaboration with RFI, a French radio station widely broadcasted in Francophone Africa, to Building capacity on snail control for SCH 57,034 US$ co-produce a radio show dedicated to the fight against NTDs in Africa. The show featured Dr. Moeti, the WHO-AFRO Other capacity-building activities to scale up 259,319 US$ Regional Director, who highlighted the role of ESPEN and the need to eliminate these debilitating diseases. Objective 2. Scale down 2019 PC-NTD Programme Manager’s meeting Two years after the first joint PC and Case Management NTD meeting in Libreville in June 2017, ESPEN and the 1,542,082 US$ ESPEN Laboratory and strengthening laboratory capacity for diagnosis of Regional NTD Programme gathered almost 300 participants, including representatives from WHO HQ and WHO- 333,540 US$ AFRO, RPRG members, programme managers from ministries of health, country NPOs, and partners, for the Second NTDs National Programme Managers meeting, co-hosted by the African Union Commission for Social Affairs, in Addis- Monitoring and evaluation impact assessment 1,106,749 US$ Ababa Ethiopia, July 16-18, 2019. Preparation of elimination dossier 6,552 US$ Other capacity-building activities to scale down 95,242 US$ This meeting guided the development of the regional NTD strategy and strategic plan for the period 2021-2030, as well as the next five-year phase of ESPEN, with the participation of NTD national programme managers, partner institutions, NGOs and donors, and WHO NTD staff members from three levels. It involved a pre-end-term review of Objective 3. Strengthen information systems the implementation of the NTD Roadmap 2012-2020 and of the NTD Regional Strategic Plan for 2014-2020. 13 687,686 US$ During the three-day meeting, participants reviewed the regional and national NTD achievements since the last Data support and coordination missions / workshops / meetings 221,306 US$ joint meeting in 2017, the challenges and constraints encountered in the region, lessons learned, and best practices 51 Developing a workbook for PC-NTDs 13,950 US$ adopted. Action points and recommendations to improve the implementation of regional and national annual plans ESPEN Portal 36,601 US$ and activities between July 2019 and December 2020 were proposed. Notably, there was a focus on the role of increased domestic financing for NTDs to ensure ownership and sustainability of NTD programmes. Botswana and Mozambique announced significant resources from their national budgets to combat NTDs at the Global Citizen 50 Objective 4. Supply chain Event in December 2019. They shared their experiences of creating political engagement and discussed with other 42,351 US$ countries how to increase domestic financing for NTDs. Finally, participants agreed on the development of the NTD regional and national goals, targets and priority interventions in line with the draft global NTD Roadmap 2021-2030. Supply chain support missions 25,701 US$ Supply chain forum and supply chain SOPs 16,650 US$ The Coalition for Operational Research on Neglected Tropical Diseases (COR-NTD) Objective 5. Partnerships and coordination Ahead of the Programme Managers meeting, there was a workshop 451,029 US$ for learning and exchange between African programme managers, Programme Managers, Steering Committee and other coordination 324,388 US$ researchers and partners working within PC-NTD programmes. meetings It was co-hosted by ESPEN and the Neglected Tropical Diseases CDS Director Office support costs 30,755 US$ Support Center (NTD-SC), which serves as Secretariat of the ESPEN governance bodies review by hera (external company) 55,927 US$ Coalition for Operational Research on Neglected Tropical Diseases Resource mobilisation strategy 39,960 US$ COR-NTD Secretariat staff members including (COR-NTD). Over the course of the one-day workshop, experiences Ahlam Awad, Mariana Stephens, Nikita McCage, and feedback were shared on existing programmatic tools that have and Waithera Kagira-Watson served as volunteers at the meeting. been developed through operational research. Participants also discussed relevant challenges that are impacting the provision of Human resources costs effective mass drug administration and how they could be addressed through operational research. In total, 158 participants representing 47 different countries attended the meeting. Overall, this event harnessed 2,391,821 US$ the energy of programme managers working towards the control and elimination targets set out for their NTDs of interest. Their invaluable input has helped shape the operational research agenda and inform the development and Programme support costs (PSC) deployment of future tools. 1,077,206 US$ References

1. WHO: Thirteenth General Programme of Work 2019−2023. Geneva: World Health Organization; 2018 (https://www.who.int/about/what-we- do/gpw-thirteen-consultation/en/, Accessed 23 January 2020). 2. UN: The Sustainable Development Goals Report 2017. United Nations, New York, NY; 2017. 3. Bangert M, Molyneux DH, Lindsay SW, Fitzpatrick C, Engels D: The Cross-Cutting Contribution of the End of Neglected Tropical Diseases to the Sustainable Development Goals. Infectious 2017, 6:73. 4. WHO: Integrating Neglected Tropical Diseases Into Global Health and Development: Fourth WHO Report on Neglected Tropical Diseases. Geneva: World Health Organization; 2017. Licence: CC BY-NC-SA 3.0IGO. 5. Lancet: Taking the Neglected out of Neglected Tropical Diseases. Lancet Global Health 2020, 8:e152. 6. Redekop WK, Lenk EJ, Luyendijk M, Fitzpatrick C, Niessen L, Stolk WA, Tediosi F, Rijnsburger AJ, Bakker R, Hontelez JA, et al: The ESPEN IS EXTREMELY GRATEFUL FOR THE LEADERSHIP AND Socioeconomic Benefit to Individuals of Achieving the 2020 Targets for Five Preventive Chemotherapy Neglected Tropical Diseases. PLoS Neglected Tropical Diseases 2017, 11:e0005289. COMMITMENT OF THE ESPEN STEERING COMMITTEE, AND THE 7. GBD 2017 DALYs and HALE Collaborators: Global, Regional, and National Disability-Adjusted Life-Years (DALYs) for 359 Diseases and Injuries and Healthy Life Expectancy (HALE) for 195 Countries and Territories, 1990-2017: A Systematic Analysis for the Global Burden of EXPERTISE AND DEDICATION OF ESPEN STAFF, WITHOUT WHOM THE Disease Study 2017. Lancet 2018, 392:1859-1922. 8. Hotez PJ, Molyneux DH, Fenwick A, Kumaresan J, Sachs SE, Sachs JD, Savioli L: Control of Neglected Tropical Diseases. New England CREATION OF THE 2019 ANNUAL REPORT WOULD NOT BE POSSIBLE. Journal of Medicine 2007, 357:1018-1027. 149. Hotez PJ, Fenwick A, Savioli L, Molyneux DH: Rescuing the ‘‘Bottom Billion’’ Through Neglected Tropical Disease Control. Lancet 2009, 373:1570-1576. 10. WHO: Global Programme to Eliminate Lymphatic Filariasis: Progress Report, 2017. Weekly Epidemiological Record 2018, 91:589-604. 11. Wanji S, Amvongo-Adjia N, Koudou B, Njouendou AJ, Chounna Ndongmo PW, Kengne-Ouafo JA, Datchoua-Poutcheu FR, Fovennso BA, 53 Tayong DB, Fombad FF, et al: Cross-Reactivity of Filariais ICT Cards in Areas of Contrasting Endemicity of Loa Loa and Mansonella Perstans in Cameroon: Implications for Shrinking of the Lymphatic Filariasis Map in the Central African Region. PLoS Neglected Tropical THE ESPEN TEAM Diseases 2015, 9:e0004184. 12. WHO: Lymphatic Filariasis Managing Morbidity and Preventing Disability. Geneva: World Health Organization; 2013. 52 13. WHO Regional Office for Africa: Neglected Tropical Disease Regional Programme Review Group Report on the First Meeting on Preventive Chemotherapy June 30-July 4, 2014 (including a report of the RPRG LF Sub-Committee Meeting held on April 23-25, 2014) WHO Regional Office for Africa, Brazzaville, Congo. Page 34. Available at http://espen.afro.who.int/system/files/content/resources/ Report_And_Recommendations_Of_1st_RPRG_Meeting_April2014_English.pdf. Accessed on February 02, 2020.

14. McGregor IA, Smith DA: A Health, and Parasitological Survey in a Rural Village (Keneba) in West Kiang, Gambia. Transactions of Dr. Maria Rebollo Polo Dr. Didier Bakajika Dr. Amir Kello Dr. Pauline Mwinzi Dr. Jorge Cano Ortega the Royal Society of Tropical Medecine and Hygiene 1952, 46:403-427. ESPEN Team Leader Medical Officer Medical Officer, Technical Officer Surveillance Officer 15. McGregor IA, Gilles HM: Diethylcarbamazine Control of Bancroftian Filariasis: Follow-up of a Field Trial in West Africa. BMJ, 1:331-332. LF & Oncho Trachoma SCH & STH 16. Knight R: Current Status of Filarial Infections in The Gambia. Annals of Tropical Medicine and Parasitology 1980, 74:63-68. 17. Rebollo MP, Sambou SM, Thomas B, Biritwum NK, Jaye MC, Kelly-Hope L, Escalada AG, Molyneux DH, Bockarie MJ: Elimination of Lymphatic Filariasis in The Gambia. PLoS Neglected Tropical Diseases 2015, 9:e0003642. 18. World Health Organization: Global Programme to Eliminate Lymphatic Filariasis: Progress Report, 2015. Weekly Epidemiological Record 2016, 91:441-455.

19. World Health Organization: Guidelines for Stopping Mass Drug Administration and Verifying Elimination of Human Onchocerciasis: Mr. Honorat Zoure Mr. Absolom Makoni Mrs. Satiane Odika Mr. Modeste Tezembong Mr. Adrien Elia Muhima Mr. Dyesse Yumba Nduba Criteria and Procedures. Geneva, Switzerland 2016. Data Manager Finance Manager Administrative Assistant Supply Chain ESPEN Collect Survey ESPEN Collect Data Manager Management Officer Support Manager 20. World Health Orgaization: Elimination of Human Onchocerciasis: Progress Report, 2018–2019. Weekly Epidemiological Record 2019, 45:513-524. 21. WHO: Schistosomiasis and Soil-Transmitted Helminthiases: Numbers of People Treated in 2018. Weekly Epidemiological Record 2019, 94:601-612. 22. Jourdan PM, Lamberton PHL, Fenwick A, Addiss DG: Soil-Transmitted Helminth Infections. Lancet 2018, 391:252-265. 23. Taylor HR, Burton MJ, Haddad D, West S, Wright H: Trachoma. Lancet 2014, 384:2142-2152. 24. WHO: WHO Alliance for the Global Elimination of Trachoma by 2020: Progress Report on Elimination of Trachoma, 2018. Weekly Mr. Levison Nkhoma Mr. Mamadou Serme Mr. Ekoue Kinvi Dr. Kebede Deribe Kassaye Epidemiological Record 2019, 94:317–328. Consultant Consultant Consultant Consultant Acknowledgements THANK YOU TO OUR VALUED DONORS FOR THEIR CONTINUOUS SUPPORT!

We wish Dr. Daniel Ngamije, former WHO NTD National Programme Officer, all the success in his new role as Minister of Health Rwanda. We strongly believe that under his leadership, ESPEN and the Ministry of Health Rwanda will continue their dynamic relationship and important collaborative efforts.

We are deeply saddened to hear the news that Dr. Yohannes Ghebrat, WHO/Eritrea, has passed away. Dr. Ghebrat was a leader at the forefront of NTD implementation in Eritrea. The ESPEN team would like to express condolences to his family and friends. May his soul rest in peace.

Schweizerische Eidgenossenschaft Confédération suisse Confederazione Svizzera Confederaziun svizra

AND SPECIAL THANKS TO THE 50 MINISTRIES OF HEALTH AND THEIR EXTRAORDINARY PARTNERS!